Well-being Programs Research Articles

Implementation of health and wellbeing policies and programs for students: Views of Australian universities.

Universities are a crucial setting to address and promote optimal mental health of young Australians. However, there is a lack of knowledge of universities' views of current implementation of health and wellbeing initiatives. Therefore, we examined the views of Australian universities on the implementation of health and wellbeing policies and programs within Australian universities. An online survey of Australian universities asked respondents to rate their level of agreement with five statements pertaining to the implementation of health and wellbeing policies and programsfor students within Australian universities using a 5-point Likert scale (strongly agree to strongly disagree). Eleven universities completed the survey (28.2% response rate). All respondents (n = 11) agreed that universities play a crucial role in supporting the health and wellbeing of their students and report access to sufficient expertise to do this. Approximately three-quarters (8/11) agreed that universities know what policies and programs to implement to support their students' health and wellbeing. There was less agreement that universities have sufficient resources (2/11 agree) or access to sufficient information about the health and wellbeing of their student population (3/11 agree) to support the implementation of health and wellbeing policies and programs. Australian universities demonstrated strong organisational commitment to supporting the health and wellbeing of their students but highlighted some key barriers to implementation. SO WHAT?: Findings from this preliminary research highlight potential barriers and facilitators to the implementation of health and wellbeing policies and programs in Australian universities, and potential foci for future research.

Health education in Christian faith-based primary schools: a scoping study

ABSTRACT Few would argue against health education’s (HE) role in optimising student wellbeing. HE can refer to health-directed curricula or non-curriculum wellbeing programs and practices, including spiritual health. This scoping review aimed to explore HE in Christian faith-based primary schools (CFBPS), which typically encourage holistic learning. Seventeen articles were examined to identify (a) How HE is positioned to support student health and wellbeing and (b) What praxes are included in HE to assist student wellbeing in Christian faith-based primary schools? Findings highlighted the research gaps, the dearth of literature and collated the article proposals to promote HE and wellbeing in CFBPS. These proposals, or ‘Five As of HE in CFBPS’, include ‘adopting’ whole school approaches to prioritise HE and wellbeing practices, ‘asking’ participants’ perspectives when planning programs, ‘applying’ the researched tools, ‘assisting’ with professional development or training and ‘associating’ HE and faith connections more overtly for student understanding.

O.2.3-2 How to effectively develop and modify workplace health programs: case studies in UK contact centers

Abstract Purpose Workplace health programs are often implemented to improve employee health, and subsequently business outcomes (e.g., reducing absence). However, they rarely consider the full range of complexity and variability of organizational factors. This can lead to poor implementation, effectiveness and sustainability. As such, innovative methods which facilitate the development or modification of health programs while considering an organization’s unique organizational culture barriers are needed. Contact center-based organizations in particular have several organizational barriers, which create highly sedentary environments with limited opportunities for physical activity engagement. This study aims to improve the development, implementation and effectiveness of workplace health programs in contact centers by identifying and addressing these barriers. Methods This study is underpinned by the Six Steps in Quality Intervention Development framework (6SQuID). 6SQuID emphasizes co-production with stakeholders which is important in ensuring interventions are acceptable and sustainable. Four workshops were conducted in two contact center-based UK organizations over seven months. The workshops, with management, aimed to accomplish the following in each organization: 1) define the problem (with wellbeing programs) and its causal factors (organizational culture barriers), and 2) co-produce theories of change, theories of action and an action plan to address the causal factors and solve the problem. Results Organization 1 (private sector, nursing services) defined their problem as: low focus on engagement and participation in wellbeing activities. Organization 2 (public sector, emergency services) defined their problem as: wellbeing programs lack proactivity, engagement and sustainability. Each organization developed an action plan to address the causal factors of their problem and initiate their theory of change pathways (desired short, medium and long-term outcomes). Activity examples included: sanctioning time for well-being program/behaviour participation (e.g., break-taking to reduce sitting) and improving program promotion. Conclusions This study provides learnings on how to facilitate more effective development (or modification) and implementation of workplace health programs (especially those related to sedentary behaviour, physical activity and mental health) by including management in identifying and addressing organizational culture barriers. Results have the potential for application to other organizations with desk-based workers. This study is part of a University of Edinburgh-funded PhD studentship.

Indigenous land-based approaches to well-being: The Sibi (River) program in subarctic Ontario, Canada

ABSTRACT The Albany River system holds a special significance for the Omushkego Cree of subarctic Ontario, Canada, embodying their cultural roots, history, and the Cree way of life and worldviews. Through the Sibi program, youth learned traditional fishing practices from Elders and on-the-land experts, gaining valuable knowledge on the land and river. The program addressed barriers to being on the land, while also creating a space for the transfer of Indigenous knowledge and revitalising community social networks. The program took place in the summer, following the Omushkego Cree’s seasonal cycle and employed community-based participatory research approach. Photovoice and semi-structured interviews were used to identify elements of well-being from an Indigenous perspective. Regardless of age or experience, participants expressed positive emotions while being on the land, highlighting how strengthening social and community networks, intergenerational knowledge transfer, and fostering cultural continuity contribute to improved well-being. Program outcomes emphasize the importance of collaboration with communities to gain insights into their needs, priorities, and values, ultimately creating more sustainable and effective well-being programs. By fostering engagement and recognizing the environment’s significance, sustainable and long-term solutions can be pursued to address challenges faced by communities, ultimately advancing health and well-being for both present and future generations.

Exposure to the Family Wellbeing program and associations with empowerment, health, family and cultural wellbeing outcomes for Aboriginal and Torres Strait Islander peoples: a cross-sectional analysis

BackgroundEmpowerment is an internationally recognised concept commonly incorporated in First Nations and in this instance Aboriginal and Torres Strait Islander health and wellbeing programs. The Family Wellbeing Program is an empowerment program developed in partnership with Aboriginal and Torres Strait Islander peoples that has been widely delivered to Aboriginal and Torres Strait Islander communities across Australia for close to 30 years. To date, there has been limited quantitative analysis of how this program is linked to health and empowerment outcomes.MethodsCross sectional analysis of Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, baseline data (n = 9,843) recruited using multi-mode random sampling including mail out survey and in community convenience sampling. Logistic regression models were performed to calculate Prevalence Ratios (PRs) and 95% Confidence Intervals (CIs) to examine the association between personal control, life satisfaction, general health, family wellbeing and cultural wellbeing outcomes for Family Wellbeing participants (n = 718) versus non-participants (n = 9,125).ResultsCompared with non-FWB participants, FWB participants are more likely to be female (67.1% versus 58.4%), be aged 35–54 (41.8% versus 32.0%) and live in a remote area (17.7% versus 10.4%) and have educational attainment at the Year 12 level or above (57.8% versus 53.2%). Family Wellbeing participation was associated with a 13% higher reporting of family functioning, a 74% higher reporting of cultural participation and a 21% in higher reporting of local decision making in the local community compared to non-FWB participants. There were significant associations between FWB exposure compared to non-FWB exposure including reporting lower levels of health risk factors including quitting alcohol (26.4% versus 20.4%), regular exercise (67.7% versus 66.3%), quitting smoking (33.4% versus 31.9%). and e. FWB participants who had experienced both prison and youth detention were nearly double that of Non-FWB (3.5% versus 1.4%) and more reported being removed from their families as children (Stolen) (7.0% versus 4.1% Non-FWB).ConclusionThere are significant associations between Family Wellbeing exposure and organisation and community level empowerment outcomes, but only for some individual level empowerment outcomes. There is a lower reporting health risk factors including increased physical exercise, reduced alcohol use and smoking; and educational attainment among FWB participants compared to non-FWB participants. The results suggest individual, community and organisational empowerment needs to be explored further with more robust study designs that can attribute causality and direction of association.

Teaching Provider Wellness and Physician Assistant Student Well-Being.

The purpose of this novel study was to determine whether any association exists between student well-being and physician assistant (PA) program approaches to teaching provider health and well-being (provider wellness). Data were sourced from 3 PA Education Association surveys. Data from the 2019 Matriculating Student and End of Program Surveys (EOPS) were analyzed to compare student-reported well-being across 6 measures. Next, data from the 2019 Didactic Curriculum Survey were assessed and matched to the 2019 EOPS data. Finally, generalized estimating equation models were used to assess the independent effects of course structure, mode of instruction, and contact hours on well-being scores among end-of-program students (within one month of graduation). While levels of well-being were generally favorable, except for "level of social activity" ( P = .20), across measures, graduating student levels of well-being ( P < .05) were statistically significantly lower than matriculating student levels of well-being. No associations were found between levels of student well-being and whether programs reported teaching or not teaching provider wellness. Some aspects of instruction (eg, contact hours) were inconsistently associated with various well-being measures. In this study, no consistent associations between approaches to teaching provider wellness and various measures of student well-being were identified. Further research is needed to determine what approaches to promoting wellness are effective.

Let's Talk About it: The Utility of Formalized Support for Medical Residents.

Medical residents are significantly impacted by burnout and depression. Recent events have only further increased the pressure and demands on the healthcare sector, intensifying the burden facing residents and posing a threat to residents' well-being. As a result, significant efforts are being made to provide formalized support and well-being programs. Yet, emergent evidence indicates that residents do not sufficiently utilize this form of support. Considering the organizational investment and focus on formalized support programs, we conducted a mixed-method study to investigate residents' utilization of formalized well-being support, and potential reasons for non-use. Our study was conducted during a period of increased work burden and stress for medical residents, where formalized support was specifically offered and targeted to medical staff. Our findings confirm earlier results of low support utilization and point to the importance of informal support mechanisms, in particular peer support. We conclude by discussing the role of managers and educational programs in facilitating a positive cultural shift to promote and support residents in seeking support.

Supporting Children's Social Connection and Well-Being in School-Age Care: Mixed Methods Evaluation of the Connect, Promote, and Protect Program.

School-age care, such as outside school hours care (OSHC), is the fastest-growing childhood education sector in Australia. OSHC provides a unique opportunity to deliver programs to enhance primary school-age children's social, emotional, physical, and cognitive well-being. This study aimed to pilot the co-designed Connect, Promote, and Protect Program (CP3) and conduct formative and process evaluations on how well the CP3 achieved its intended aims, ascertain areas for improvement, and determine how the CP3 model could be better sustained and extended into OSHC settings. A naturalistic formative and process evaluation of the CP3 implementation was undertaken at 1 and then 5 OSHC sites. Qualitative and quantitative feedback from stakeholders (eg, children, OSHC educators, volunteers, and families) was collected and incorporated iteratively for program improvement. The formative and process evaluations demonstrated high program engagement, appropriateness, and acceptability. Co-design with children was viewed as highly acceptable and empowered children to be part of the decision-making in OSHC. Feedback highlighted how the CP3 supported children in the 4 CP3 domains: Build Well-being and Resilience, Broaden Horizons, Inspire and Engage, and Connect Communities. Qualitative reports suggested that children's well-being and resilience were indirectly supported through the Broaden Horizons, Inspire and Engage, and Connect Communities CP3 principles. Matched-sample 2-tailed t tests found that children's prosocial behaviors increased (mean difference=0.64; P=.04; t57=-2.06, 95% CI -1.36 to -0.02) and peer problems decreased (mean difference=-0.69; P=.01; t57=2.57, 95% CI 0.14-1.13) after participating in the CP3. Program feasibility was high but dependent on additional resources and CP3 coordinator support. To our knowledge, the CP3 is the first co-designed well-being program developed and evaluated specifically for OSHC services. This early evidence is promising. The CP3 may provide a unique opportunity to respond to the voices of children in OSHC and those that support them through creative and engaging co-designed activities. Our research suggests that CP3 provides OSHC with a framework and high-quality program planning tool that promotes tailored interventions developed based on the unique needs and preferences of those who will use them.

Sustaining an Aboriginal wellbeing program: Informing health promotion practice and policy.

Aboriginal and Torres Strait Islander Peoples' holistic concepts of wellbeing are inadequately represented in the health promotion discourse. The aim of this article was to explore what sustains an Aboriginal wellbeing program, to inform critical reflection and reorientation to empower Aboriginal wellbeing approaches in health promotion practice and policy. Aboriginal and non-Indigenous researchers collaboratively designed a critically framed, strengths-based research approach with Aboriginal Community Controlled Health Service staff and wellbeing program participants. Data from Individual Yarning (n = 15) with program participants and staff inspired co-researchers to co-develop interpretations over two half-day Collaborative Yarning sessions (n = 9). Co-researchers depicted five lifeworld qualities that sustain an Aboriginal wellbeing program: love, connection, respect, culture and belonging. The lifeworld qualities are relational, communicative and involve the dynamics of identity, power and self-determination. The five qualities support a lifeworld approach to an Aboriginal wellbeing program, opening communicative and relational opportunities to mediate culturally responsive interactions. The qualities mediated interactions between people in the lifeworld including program participants and coordinators, and systems representatives including health service providers. A lifeworld approach provides a way to empower Aboriginal self-determination and leadership through embedment of cultural determinants of health in wellbeing programs. SO WHAT?: Health service providers and policy makers can use lifeworld approaches to guide critical reflection and reorient practice and policy related to Aboriginal health. The lifeworld qualities that encompass this approach in wellbeing programs are communicative and relational, centred on local community voices and co-produced with community for Aboriginal identity, empowerment and self-determination.

Outcome of capacity building in mental health for well-being volunteers.

Volunteering is any activity in which time is given to assist another individual, group, or organization. It assists people who want to get involved in philanthropic programs that help volunteers develop awareness and lead healthier personal and social lives. Several volunteers have received specialized training in the fields in which they volunteer, such as health, mental health, education, or emergency rescue. Volunteers are rendering intervention in different areas in mental health. They are providing psychosocial support to the individuals, groups, community, promoting mental health through conducting various mental health awareness programs in the community. There is a growing concern about mental health in India due to the inaccessibility of services. The National Institute of Mental Health and Neuro Sciences (NIMHANS) being a premier institute for mental health, is devising innovative approaches to mental health care to reach the unreachable. One such initiative was to build the capacity of volunteers in the community who are interested in working for the cause of mental health. The objective of this study was to evaluate the outcome of the well-being volunteer program. This study used a descriptive cross-sectional research design, wherein all the 136 trained well-being volunteers (WBVs) were included as the study sample. The data was collected from the volunteers who attended the WBV program, which was initiated by NIMHANS Centre for Well-being (NCWB) and the Department of Psychiatric Social Work NIMHANS. A questionnaire on the outcome of the Well Being Volunteers program was developed for the study, and the Volunteer Motivation Inventory scale was used to collect the data from the WBVs. SPSS software was used to analyze the data. Ethical clearance was sought from the Institute Ethics Committee of NIMHANS. The WBV program enhanced volunteers' knowledge of mental health and benefited the volunteers in their personal and social life. They were also able to implement a satisfactory level of mental health-related volunteer activities in the community. Results of present study and the available literature suggest that engaging in voluntary services improves mental health knowledge. WBV program has provided opportunity to Volunteers to participate in mental health delivery system at different levels.

Four Steps To My Future (4STMF): acceptability, feasibility and exploratory outcomes of a universal school-based mental health and well-being programme, delivered to young adolescents in South Africa.

Mental health disorders affect many children in South Africa, where vulnerability is high, and treatment is limited. We sought to determine the feasibility and acceptability of a universally delivered classroom-based programme for the promotion of mental health in young adolescents. We pilot tested an 8 session, cognitive-behavioural therapy-based programme, 4 Steps To My Future (4STMF) in two schools. Participants were grade 5 learners (n = 222; Meanage = 10.62 (Standard deviation = 0.69)). 4STMF was delivered in class time by trained psychology postgraduates. Feasibility (rates of parental opt-out, child assent, assessment completion at baseline and follow-up, programme completion, session attendance and programme fidelity), acceptability (teacher feedback and focus groups with learners), as well as demographic data and data on a battery of a psychological measures were collected at baseline, postintervention and at one-month follow-up. Most eligible learners at both schools agreed to participate (85% - school 1; 91% - school 2) with more than 80% completing postintervention measures. Learner session attendance and programme fidelity were high. Teachers rated facilitators highly on confidence, preparedness, enthusiasm and classroom management and observed children to be enjoying the programme. Focus group data suggest that learners liked the programme, could recall the content and had shared some of the content with their family. An exploratory analysis of outcomes showed significant pre-post differences on self-esteem at school 1 and on emotion regulation at school 1 and school 2, maintained at follow-up. This pilot study has shown that 4STMF can acceptably and feasibly be delivered, at classroom level, as a universal school-based prevention programme to young adolescent learners in South African primary schools. The programme could fit in with school context, could be delivered by nonspecialists, showed significant improvements on self-esteem and emotion regulation and was liked by the learners.

Handling and Training of Wild Animals: Evidence and Ethics-Based Approaches and Best Practices in the Modern Zoo.

There is an ethical responsibility to provide all animals living in human care with optimal and positive well-being. As animals living in zoos and aquariums frequently interact with their human caregivers as part of their daily care routines, it is both relevant and essential to consider the impact of these interactions on animal well-being. Allowing animals to have choice and control in multiple areas of their lives, such as by providing opportunities for them to voluntarily participate in their own care through, for example, positive reinforcement training, is an essential component of good animal well-being programs. This review aims to describe evidence-based approaches, ethics, and best practices in the handling and training of the many taxa held in zoos and aquariums worldwide, drawing from work in related animal care fields such as laboratories, farms, rescue, and sanctuaries. The importance of ongoing animal well-being assessments is discussed, with a particular focus on the need for continued review and refinement of processes and procedures pertaining to animal training and handling specifically. Review, enquiry, assessment, evaluation, and refinement will aim to dynamically support positive well-being for all animals.

Feasibility of a Mental Wellbeing Program for Rural Family Childcare Home Providers

Feasibility of a Mental Wellbeing Program for Rural Family Childcare Home Providers

Museum-based art therapy and wellbeing programme: experiences of veterans with PTSD

ABSTRACT Background Engaging in creative arts and heritage have both been shown to improve wellbeing. Aim: The aim of the current study was to explore veterans’ experiences of attending the Creative Wellbeing Programme programme (CWP) in a military museum. Methods Seven veterans who attended the CWP programme were invited to share their experiences through a qualitative, semi-structured interview. The interview explored experiences of engaging in this type of programme and the impact this had on them. The interview was transcribed, and a thematic analysis was conducted. Results Themes concerned three stages of involvement: Pre-programme, Programme experiences, and Post-programme. Pre-Programme themes concerned reasons for participation, pre-programmes feelings, hopes and expectations. Programme Experiences concerned general experiences, the role of social support, the role of the museum, and the art therapy process. Post-Programme themes concerned perceived outcomes. Overall, the museum created a relaxed and informal environment, and the familiar items in the museum stimulated the creative process. However, for some this led to disengagement due to fear that objects may prompt negative emotions. Conclusions The findings suggest that engaging veterans in art therapy in a museum environment is beneficial. Future programmes should aim to focus on support post intervention. Implications: The study provides insight into the acceptability of art therapy within a military museum environment. It also adds to the growing international evidence concerning the role museums have in supporting mental health and wellbeing. Plain language summary This study aimed to explore the experiences of veterans who took part in a Creative Wellbeing Programme (CWP). This programme involved using art and discussion in a museum environment as a way of supporting veterans with potentially traumatic memories. The group environment facilitated connection and a sense of belonging through discussion of museum items. Seven veterans were interviewed via MS Teams about their experiences engaging in the programme, exploring potentially positive and negative aspects of participating. The transcripts were transcribed by MS Teams and anonymized before being analysed for potential themes. Themes were identified relating to pre-programme, during the programme and following the programme. Pre-programme themes were centred on the reasons veterans participated, and their hopes and expectations about the programme. Programme themes were the role of social support in the groups, the role of the museum, art therapy process. Post-programme themes centred on the outcomes veterans felt had resulted from taking part in the programme. Overall, the familiar items in the museum facilitated discussion and creativity despite some veterans feeling that the items prompted negative emotions. The study findings indicate the potential benefits of a museum group environment for veterans experiencing mental health difficulties.

Transformational Mentoring Experiences for First Nations Young People: A Scoping Review

ABSTRACT While Aboriginal youth mentoring has been used as a teaching process for thousands of years and the tradition continues, little attention has been paid to documenting what elements make learning experiences transformational. As part of the evaluation of the Aldara Yenara mentoring program, this Aboriginal-led scoping review examined literature about transformational mentoring programs from Canada, Australia and Aotearoa New Zealand to understand their key elements and provide guidance for future research and practice. The use of relational mapping was applied in an attempt to locate literature written by Aboriginal scholars including grey literature. Twenty-seven documents were reviewed including 20 from the peer-reviewed literature and seven acquired through the relational mapping. A total of 13 met the inclusion criteria, predominantly written by non-Aboriginal authors. Four distinct themes emerged and informed our narrative synthesis. Absent in this material, largely neither led nor owned by Aboriginal people, was any reference to connection to Country as central to Aboriginal transformational healing programs. Without Aboriginal leadership, communication and processes in these programs, there was a failure to draw on Aboriginal understandings of healing spaces. From here on in, research and practice in this area must be Aboriginal-led to ensure deeper, Aboriginal-informed understandings for First Nations transformational mentoring programs. IMPLICATIONS Existing youth mentoring literature is dominated by western understandings and perceptions. Thus, it often fails to offer the nuanced benefits of Aboriginal youth holding or growing their relationship to Country for their wellbeing and personal development Mentoring programs that are culturally strong from First Nations worldviews are key to providing transformational experiences: that is, cultural connectedness encourages, motivates, and creates healing spaces for Aboriginal youth While social work has facilitated normative western narratives for youth and their wellbeing, future Aboriginal mentoring program need to be both led and evaluated by First Nations people.

Opening the black box of school-wide student wellbeing programmes: a critical narrative review informed by activity theory.

Medical schools have a duty of care to support student wellbeing but there is little guidance on how to translate this mandate into practice. Often schools focus on implementing and reporting individual-level interventions which typically only address one aspect of wellbeing. Conversely, less attention has been paid to holistic school-wide approaches towards student wellbeing that address multiple wellbeing dimensions. Thus, this review sought to improve our understanding of how support is mediated within such school-wide wellbeing programmes. This critical narrative review was conducted in two stages. First, the authors searched several key databases for papers published up to 25th May 2021, using a systematic search strategy and TREND checklist to guide our data extraction process. We later expanded our search to include literature published from the original date to 20th May 2023. Second, the identified articles were critically analysed using activity theory as a theoretical lens to aid explanation. We found school-wide wellbeing programmes emphasize social connectivity and building a sense of community. Tutors take a key role in the activity of supporting students' wellbeing. We mapped out the activity system components to describe the complexity of this tutor role. This analysis illustrated: tensions and contradictions in the system which may open up opportunities for change; the importance of context for influencing how system components interact; and that students' trust underpins the whole activity system. Our review shines a light into the black-box of holistic school-wide wellbeing programmes. We identified that tutors play a key role in wellbeing systems but confidentiality is a recurring tension which may jeopardise a wellbeing system. The time has come to investigate these systems in more detail, embracing and exploring the role of context at the same time as looking for common threads.

Peer support after exposure to trauma: an evaluation

Background: There are various staff wellbeing programmes used across the emergency services. The British Military recognised single-session models were not effective and developed Trauma Risk Management (TRiM). A number of organisations now use TRiM as a peer-led traumatic stress support system, including the North West Ambulance Service. Aims: This evaluation aimed to identify engagement with TRiM across the North West Ambulance Service. Method: A combination of quantitative and qualitative data was analysed from those who engaged with TRiM. Findings: There was a perception that road traffic collision (RTC) and cardiac arrests would cause acute stress symptoms and require a TRiM assessment; this was validated by the uptake of assessments and referral to professional counselling following such incidents. Conclusion: TRiM can provide effective peer-delivered support across a large geographical workforce. Implementation and coordination are key to ensuring success.

Enabling dads and improving First Nations adolescent mental health: a pragmatic randomised controlled study

IntroductionThere are few empirically supported social and emotional well-being programmes for First Nations adolescents, and we found none targeting those living in Aboriginal communities in remote areas of Australia. The...

Utilization of whole health services among veterans with spinal cord injuries and disorders (SCI/D): Early insights from the VA SCI/D system of care

Context/Objective Our objective was to describe early participation in Whole Health programs across the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) System of Care. Design Retrospective analysis of VHA administrative data. Setting The VHA SCI/D System of Care. Participants Veterans with SCI/D included in the FY2019 cumulative VHA SCI/D Registry cohort with living status during FY2017, FY2018, and FY2019. Interventions N/A. Outcome Measures We assessed the number of encounters and unique Veterans with SCI/D, and the percent of Veterans with SCI/D, who utilized each Whole Health (WH) program available in VA. Results Utilization of WH Pathway and well-being Programs increased from 62 encounters to 1703 encounters between FY2017 and FY2019 (representing 0.09% to 3.13% of Veterans with SCI/D). Utilization of chiropractic care rose from 130 encounters to 418 encounters during the same time period. Similarly, utilization of complementary and integrative health programs increased from 886 encounters to 2655 encounters (representing 1.09% to 3.11% of Veterans; FY2017 to 2019). We also report utilization of specific WH programs. Conclusion Participation in WH services has been increasing among Veterans with SCI/D who receive health care from the VHA SCI/D System of Care. However, utilization among Veterans with SCI/D remains low overall, and targeted efforts to increase WH program reach are needed. Additional information about the relative effectiveness of different strategies to support WH implementation is also needed, to ensure strategies likely to have the most impact are prioritized.

Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders

BackgroundWith their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus.MethodsWe conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke’s reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework.ResultsLocal governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO’s.ConclusionsLocal governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government’s capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.