CENTRE FOR REMOTE HEALTH
Phil Entwistle
Senior Lecturer/Researcher
P: +61 8 8971 2758
E: philip.entwistle@flinders.edu.au
Developing evaluation capacity with local NGOs
For the last three years the Centre for Remote Health (CRH) and Australian Rural Health Education Network (ARHEN) have had a successful collaboration with Amity Community Services in Darwin. Amity Community Services are an incorporated non-government community organization who provide a range of services to assist people with behavioural and lifestyle problems.
During 2006 Amity initiated a project to address the harmful use of solvents in the Darwin/Palmerston area and received funding from the Department of Health and Ageing. Following completion of the project AHREN in conjunction with CRH successfully tendered for and subsequently completed the evaluation. Amity received a further three years funding to extend their work in this area and developed a project entitled Alcohol and Other Drugs (AOD) Indigenous communities project. ARHEN and CRH were contacted by Amity concerning the evaluation. From the lessons learned in the initial evaluation Amity wished to take an active role in the design and conducting of the evaluation and also wanted the evaluation to be an integral part of the project from the start.
Using an action research approach CRH PHCRED ‘Top End’ team comprising of Phil Entwistle, Kylie Stothers and Karen Piper collaborated with Amity project team to develop an evaluation plan which linked with the project plan and reporting structure. A number of workshops were designed and completed to achieve this end. Following the completion of the contract CRH continue to work with Amity under the PHCRED banner to assist in questionnaire design, data collection techniques and report write up, and a number of workshops and field trips are to be conducted. Further collaboration is also being planned in the form of a capacity building project in three Indigenous communities in the Darwin area which will involve the communities researching their oral histories. This will be facilitated by Amity Indigenous project staff and supported by CRH PHCRED team, particularly Kylie Stothers the Indigenous Research Associate at Katherine Campus.
A paper on Building evaluation capacity in non government organizations: an action research approach was presented by Phil Entwistle at the 2009 GP & PHC Research Conference.
This presentation can be viewed at <www.phcris.org.au/conference/browse.php?catid=874>
Editor
DEPARTMENT OF RURAL AND INDIGENOUS HEALTH
MONASH UNIVERSITY
Janice Chesters
Acting Director
P: +61 3 5128 1009
E: janice.chesters@med.monash.edu.au
Monash University Department of Rural and Indigenous Health (MUDRIH) researchers are currently working on a four part study exploring the iodine status of the Gippsland population and factors affecting that status. Leading the study is PhD student Dr Ashequr Rahman. Other members in the research team are Associate Professor Janice Chesters and Dr Gayle Savige from MUDRIH, and Dr Nick Deacon and Dr Barbie Panther from the School of Applied Science and Engineering at Monash Gippsland
Australia overall is iodine deficient. However, in the National Iodine Nutrition Study (NINS), Victoria had the worst status with regard to iodine deficiency in school children. Our study focuses on regional and sub regional iodine status, which extends the work of the NINS team and will provide data on the situation in Gippsland.
Preliminary results from historical research, water testing, retrospective neonatal thyroid data analysis and urinary iodine excretion measurement among pregnant women indicate dietary iodine deficiency may be a re-emerging problem in the Gippsland region. Even mild iodine deficiency in pregnancy is a risk factor for babies as it may result in their impaired intellectual development; this is the most serious consequence of dietary iodine deficiency.
Findings from this study may help to make the Nationwide Iodine Supplementation Programme being implemented by Food Standard Australia and New Zealand (FSANZ) more focused, targeted and relevant to pregnant women and their babies.
UNIVERSITY DEPARTMENT OF RURAL HEALTH NORTHERN NSW
UNIVERSITY OF NEWCASTLE
Dr Precious Lusumbami
O&G Registrar, RDP Fellow
E: precious.lusumbami@hnehealth.nsw.gov.au
Sherylyn Crisp
Psychologist, RDP Fellow
E: scrisp@nwsdp.org.au
Dr Precious Lusumbami, a Registrar in Obstetrics and Gynaecology (O&G), has recently transferred from Tamworth Rural Referral Hospital to Armidale. Originally from Zimbabwe, Precious completed her medical training before moving to England in 2002, and then to Australia in 2007.
Precious is consulting the literature to develop an up-to-date review of smoking cessation programs that are appropriate and effective to use with pregnant Indigenous women. She intends to undertake O&G training next year which includes a requirement to carry out research. As she wants to practise in regional Australia, working with Aboriginal women, Precious expects her RDP training will help her understanding of the cultural issues in the Aboriginal community.
Sherylyn Crisp is a Psychologist working part time at North West Slopes (NSW) Division of General Practice with Life Solutions North West, providing psychological services to Tamworth and an outreach service to Walcha.
While undertaking her RPD Fellowship Sherylyn will be conducting research into the impending changes to Australian Psychology accreditation and the potential impact for psychologists working in primary health care within rural and remote areas. The aim of her research is to explore rural psychologists’ perceptions of the future changes to psychology and to develop further understanding of how this may affect primary health care provision.
Sherylyn will conduct a qualitative study using semi-structured interviews of Psychologists working in rural and remote primary health care positions within the Hunter New England area.
DEPARTMENT OF GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Hagen Tuschke
PhD Student
P: 0405 279 305
E: tuschkeh@unimelb.edu.au
Mastering the Magic of Presentation Skills
In May, postgraduate students from the Department of General Practice organised a seminar on presentation skills and techniques with Allan Parker, a master presenter and communicator. This stimulating event was made possible by funding from the Melbourne School of Graduate Research Academic Activity Grant Program and PHCRED. With the catchy title Mastering the Magic of Presentation Skills, the seminar was held in the Graduate Centre’s Gryphon Gallery at the University of Melbourne
Held at no cost to attendees, this event was part of the student group’s efforts to revitalise departmental student activities with the audience being postgraduate students, PHCRED fellows and academic staff.
In his presentation, Allan Parker provided an overview of how to create rapport with an audience and explained some unique strategies for assessing audience responses (and responding to them) as well as how to ensure that presentations are entertaining, clear, serious, humorous, dynamic and sensitive.
The attendance of some 30 participants from the Department was indicative of strong interest in the topic. Feedback from attendees about the presentation was very positive, with many favourable comments about Allan Parker’s extraordinary presentation skills; and many expressed appreciation for the opportunity this event provided to develop fraternity between students, PHCRED fellows and departmental staff.
Participants were grateful for the support provided by the Head of Department, Prof Jane Gunn; and to have had senior academic staff, Including Prof Doris Young and A/Prof Meredith Temple-Smith, in attendance.
DISCIPLINE OF GENERAL PRACTICE
UNIVERSITY OF SYDNEY
Dr Raechelle Rubinstein
PHCRED Coordinator
P: +61 2 9556 7200
E: raechelle@gp.med.usyd.edu.au
Our three RDP Fellows are busy working on their research projects. They are exploring important and very different topics.
Rebecca Hensley is a paediatric nurse at The Children’s Hospital at Westmead and an MPhil candidate at Sydney University. Her research topic is A systematic review of adenoidectomy as treatment for obstructive sleep apnoea (OSA) in children. The project is relevant to general practice because GPs are usually the first port of call when children have chronic obstructed breathing and also neurocognitive and behavioural issues due to OSA.
Christopher Daniel, a Project Officer at Central Sydney General Practice Network, is examining a topic that has particular relevance to the area of Sydney where he works. Coordinating Health Care in Culturally and Linguistically Diverse General Practices in Sydney will consider, among other things, how team care is coordinated in those practices
Debra Clark is a Project Officer at GP Network Northside. She is exploring if and how a patient held (paper-based) record could be useful as a tool to assist diabetic patients to self-manage their condition. Self-management education may improve outcomes for patients and reduce costs, and it seems that self-management education for chronic illness may soon become an integral part of high-quality primary care.
The Youth Health Research Interest Group (YHRIG) facilitated a Breakfast Session at the GP & PHC Research Conference. The session was entitled: What is YHRIG and what are our aims? A variety of topics were dealt with including empowering General Practice (GPs, GP registrars, Practice Nurses and medical students) to better manage youth health through education, adequate remuneration for GPs to conduct preventative health consultations with young people and breaking down barriers to improving young people’s health.
CENTRE FOR PRIMARY HEALTH CARE & EQUITY
UNIVERSITY OF NEW SOUTH WALES
Suzan Mehmet
Research Network Coordinator
P: +61 2 9616 8520
E: s.mehmet@unsw.edu.au
UNSW RDP program crucial to PhD success – Sue Kirby Profile
Current University of New South Wales PhD candidate Sue Kirby, describes the Researcher Development Program (RDP) as a ‘made to order stepping stone’.
Sue came to the Researcher Development Program in mid 2006 with a wealth of health sector experience, including Director of Community Health in the Illawarra and Shellharbour Hospital.
“What to do with a tired old manager?” quipped Sue decked out in her signature purple. After a stint of consultancy and teaching work at the School of Public Health and Community Medicine, UNSW, Sue was looking for a new challenge and was encouraged to apply for a RDP position.
Based at the UNSW Centre for Primary Health Care and Equity (CPHCE) Sue gained practical research skills experience with several key projects including SNAP, 45 Health Check and Teamlink.
“It was great to work in teams and on different projects and also have different supervisors. I had great support. The people at CPHCE were helpful and welcoming”.
Whilst on the RDP placement, Sue had the opportunity to contemplate ideas for a PhD thesis, discussing these with CPHCE colleagues. After completing the placement with two publications, a report and the runner up prize for her poster at the 2008 GP & PHC Research Conference, Sue had the confidence to embark on a PhD.
“I wouldn’t do the PhD without it! It gave me a taste and an understanding of research. I’m eternally grateful. I wouldn’t have gone straight into research. It would have been too big a step. It was a great opportunity to find out, did I like research and does it like me?”
Her PhD explores patient attitudes and if they contribute to hospital readmissions. Her supervisors are Professor Mark Harris and Dr Sarah Dennis. The research encompasses two parts: the analysis of emergency presentation data and interviews with clinicians and patients. Currently Sue has completed her mixed method data collection and is now analysing the data and intends to submit her thesis in 2010.
GENERAL PRACTICE AND RURAL MEDICINE
JAMES COOK UNIVERSITY
Robyn Preston
PHCRED Coordinator
P: + 61 7 4796 3383
E: robyn.preston@jcu.edu.au
Designed for busy practitioners, the Graduate Certificate in Primary Health Care Research can be studied externally; part time over one to two years. Three of our students give feedback on the course.
Hilary Waugh says: I have completed the first subject Contemporary Issues in Primary Health Care Research. I hoped the course would help build my knowledge and give me skills which I could apply directly to my work. I gained all this and more. I definitely have a much greater understanding and capacity regarding the planning and conduct of research projects. This has given me confidence as well as an ability to add value to my work. My coursework has also provided me with a bank of resources which I refer to regularly. I have confidence that the information sources I use are the right ones! I found the course to be very well structured and comprehensive. The course coordinators and facilitators were highly competent people who provided us with one-to-one support as well as good quality feedback about our work. I have been really impressed and would recommend this course to anyone working in the health sector who has an interest in research or health-related project work.
Anne Li says that the course has improved the quality of the qualitative research project she is currently undertaking in her workplace, a major metropolitan hospital. "Experienced clinicians are in a unique position to engage in research which will have immediate benefits for the patients we work with. The only thing stopping us is the knowledge of how to go about conducting rigorous, high quality research within a clinical setting. This course provides not only the information we need, but also a supportive learning environment where I have been able to have regular discussions and exchange ideas with my lecturers and fellow students on the online discussion board."
Ornissa Naidoo comments that "This course has been great in providing information that has not only helped in my clinical position, but also in project work that I am doing. It broadens the holistic understanding of research from writing for grants, ethics submission to analysis of data. It also encourages you to look at quality improvement activities in a different light. The lecturers are very supportive and that is very important as a remote student".
Further information about this course is available at <www.jcu.edu.au/medicine/prospective/JCUPRD_031416.html>
SCHOOL OF MEDICINE
GRIFFITH UNIVERSITY
Libby Holden
PHCRED Research Administrator
P: +61 7 3382 1364
E: l.holden@griffith.edu.au
Griffith University and Queensland Health Metro South are working collaboratively on a pilot project to promote research culture in primary health care. A range of research capacity building activities are provided to participating teams, including research skills training and a mentoring scheme which supports teams to conduct a small research project relevant to their service.
An example of a team project is the one being conducted by the Queensland Health Children’s Development Service. Their project explores developmental delays potentially associated with children having been diagnosed with positional plagiocephaly (a malformation of the head). Since 2000, and campaigns to prevent Sudden Infant Death Syndrome, there has been a dramatic increase in the incidence of positional plagiocephaly which has been linked to neurodevelopmental delays. However, limited information about the specific types of delays is currently available. This project will inform clinicians as to possible developmental delays to be aware of and will identify possible directions for further research into the prevalence of particular developmental outcomes for children with a history of positional plagiocephaly.
As this collaborative research capacity building initiative is still in the pilot stage, a pilot evaluation framework is also being developed concurrently. The evaluation uses a pre-post intervention study design with control teams matched to intervention teams based on role and approximate team size. Baseline data is being used to conduct initial validation of the main evaluation tool. The tool aims to measure research capacity and research culture at an individual, team and organisational level. Further validation of the tool is planned in the near future. It is hoped that, with renewed PHCRED program funding, this project will be undertaken again with a more rigorous evaluation framework and with improvements to the interventions gained from conducting the pilot program.
SCHOOL OF POPULATION HEALTH
UNIVERSITY OF QUEENSLAND
Assoc Prof Jon Adams
PHCRED Mid-Career Research Fellow
E: j.adams@sph.uq.edu.au
In 2007, I was awarded a PHCRED Mid-Career Fellowship (2007-2011) based around my work examining the relationship between primary care and complementary and integrative medicine (CAM). The Fellowship has provided an excellent opportunity for me to concentrate upon my research fieldwork and output and there have been a number of exciting developments in the last two years – I highlight a number below.
Last year I received two large NHMRC grants as CIA to further develop my CAM and primary care program – one examining the use of CAM by mid-age women across urban and rural Australia ($450,177) and another exploring the experiences of CALD family-caregivers for people living with dementia in relation to both conventional and CAM care ($434,176). Accompanying these ongoing projects, I also have three edited research books under contract since 2008 – I am Editor-in-Chief of the first International Reader in Traditional, Complementary and Integrative Medicine (Palgrave MacMillan, UK), first editor of a collection examining Primary Care and Complementary and Integrative Medicine (Imperial College Press, London) and a co-editor of a collection looking at Evidence Based Healthcare in Context: Critical Social Science Perspectives (Ashgate, UK)
Since late last year I have founded and currently direct an international research network (NORPHCAM – Network of Researchers in the Public Health of Complementary and Alternative Medicine). Our network, which has to date attracted over 40 international core collaborators, is currently preparing for an inaugural conference to examine the relationship between public health/health services research and CAM. This will be the first such conference worldwide and our aim is to secure this as a regular event on the international stage. One area of focus within our broad research program is to examine a number of issues around the interface between CAM and primary health care. For more information on NORPHCAM and our forthcoming conference please visit our website <www.norphcam.org>.
Finally, I am honoured to have recently been awarded a place as part of the Brisbane Initiative Senior Academic Peer Learning Set (2010-2012) run by the Department of Primary Health Care, University of Oxford. The BI award will provide additional experiences and insights regarding leadership in primary health care research and I am very much looking forward to collaborating with and learning from a range of senior academics as part of this international program.
Spencer Gulf Rural Health School
Judy Taylor
Senior Research Fellow PHCRED Mid-Career Research Fellow
P: 0427 610 169
E: judy.taylor@unisa.edu.au
What a privilege to be able to focus on primary health care research and in particular, a program of work relating to community participation in community health development in rural, regional, and remote communities. One of my current areas of interest is to develop a conceptual framework for effective community/health sector partnerships in primary prevention (in partnership with Dr Margaret Cargo, University of SA and Associate Professor Annette Braunack-Mayer University of Adelaide). The importance of community involvement in primary prevention of mental and chronic illness is undeniable. The health sector alone has not the resources or the expertise to deal with all the aspects that need attention if we are to delay the onset of, or prevent chronic illness. Communities are effective allies although at times their activities are unrecognised by the health sector.
Eight case studies are planned (two are completed) in regional Australia examining partnerships between communities and the health sector examining the type of partnership (type meaning the conceptual approach), the motivations of partners, and key elements including community participation, knowledge transfer, and bridging social ties. Already it is clear that conceptual typing of partnerships is problematic because power relationships are continually shifting and the health sector and communities usually have differing motivations for involvement. However, just identifying these issues will assist making explicit some of the reasons why benefits of partnerships between communities and the health sector are rarely optimised. Finding out what type of partnership suits what type of ‘intervention’ will provide information for translation to improve partnership working.
PRIMARY CARE RESEARCH UNIT, DEPARTMENT OF GENERAL PRACTICE
UNIVERSITY OF MELBOURNE
Marie Pirotta
Chair of VicReN, PHCRED Senior Research Fellow, General Practitioner
P: +61 3 8344 9723
E: m.pirotta@unimelb.edu.au
VicReN, the Victorian Primary Care Practice-Based Research Network, was established two years ago as a means of enhancing the research links of our department and the general practices in our community. Aims of our research network include engaging GPs in research activities and building research capacity.
Often when planning research interventions to be tested through general practices, research teams have neglected to involve the primary care practitioners themselves. Lack of understanding of the environment and constraints under which general practice clinics operate has lead to projects that either fail to engage GPs and general practice staff, or interventions that do not fit well into busy bustling general practice workflow. Projects have overburdened and discouraged practices and practitioners.
The reality of much of the primary care research conducted through the Department of General Practice is that it relies on the interest and goodwill of both primary care staff and patients. Usually, participants are recruited through individual general practices and at least part of the data collection needs to occur at the practice level.
VicReN has developed a successful approach to ensuring that the research it supports respects the operation of general practice: the formal role of General Practitioner (GP) Adviser or Practice Nurse (PN) Adviser within the project team. Having now adopted this model in several large general practice-based studies, we have found that a GP Adviser and/or Practice Nurse Adviser can be vital in assisting researchers to develop and refine the study protocol to ensure acceptability to practices, relevance to patients, and make certain that the research can be placed in general practices with the least possible impact on the daily activity of the practice.
The benefits are mutual, with the GP or PN advisor also learning more about research through their experiences on the research team.
Discipline of General Practice
UNIVERSITY OF QUEENSLAND
Geoff Mitchell
PHCRED Senior Research Fellow
P: +61 7 336 55504
E: g.mitchell@uq.edu.au
The Patient-held Palliative Care Record
Discharge planning is a complex task. It is vital for patients who have serious illness to have a smooth transfer of information to the health professionals that will have responsibility for their care. This is never more evident than in palliative care, where a return home is often so they can die in the place of their choosing.
We conducted an in-depth examination of the discharge planning program of a major tertiary hospital, with the intent of developing a discharge planning process that improved patient outcomes. We found that discharge was often rushed, and distressing to patients and carers because of information overload and having to tell their story to a retinue of health professionals. We developed a patient-held record, a palliative care plan, and documentation for case conferences to facilitate planning for complex cases. The whole process was pilot tested, and then implemented in January 2008. A before and after cohort study evaluated the impact on patient wellbeing, and the degree to which the patient felt in control of the situation.
We found that the new discharge planning project did not lead to improved quality of life, but did improve the patient’s perception that they had control of the situation. In addition, nurse observations of the patients both in hospital just before discharge and in the community showed improvements in parameters like being more involved in their care, less time wasted with health professionals and improved ability to communicate with relatives. Feedback showed that all parties to the project were impressed with the utility of the materials developed.
This project was ambitious because it represented an attempt by an outside agency to assist in changing practices inside a hospital. This did appear to be the case, but a lot of work is required to sustain the new practice now that the project has finished.
PHCRED TRI-STATE
Elena Dibez
PHCRED Tri-State Coordinator
P: +61 8 7221 8535
E: elena.dibez@flinders.edu.au
Tri-State Program looking outwards in 2009
The PHCRED Tri-State program is a collaboration between the University of Adelaide, Flinders University, the Spencer Gulf Rural Health School in South Australia, the Centre for Remote Health in the Northern Territory and the Greater Green Triangle University Department of Rural Health in Victoria.
The PHCRED Tri-State Program is looking outward to establish strong links with policy makers and health practitioners. This was the focus of the recent Network Forum Making Research Work for Better Health held in Adelaide in June. Over 30 people attended the Forum at the National Wine Centre to hear up dates on PHCRED programs in South Australia. The Forum was also addressed by: Mr Hitendra Gilhotra, Director, Strategic Research Evidence Section, Australian Government Dept of Health and Ageing; Ms Heather Petty, Principal Project Officer, Strategic Research, Health SA; and Dr Helena Williams, CEO, General Practice Network South.
The Tri-State program sees its role as assisting PHCRED programs in South Australia, Northern Territory and the Greater Green Triangle in making the connection between primary health care researchers, practitioners and policy makers, thereby improving the relevance and impact of research.
The Annual Tri-State Conference in Alice Springs on 24-25 September will continue this theme. An invitation has been extended to local health organisations in the Northern Territory and Government department representatives to attend the Conference. Key Speakers at the Conference will be Professor John Wakerman from the Centre for Remote Health and Professor Lesley Barclay from Northern Rivers University. The Honourable Warren Snowden Federal Minister for Indigenous Health, Rural and Regional Health and Regional Services Delivery has accepted an invitation to open the Conference.
Other PHCRED Tri-State activities this year will include skill building workshops in: Qualitative Research, Critical Analysis and Career Pathways. The program will also host a visit by Professor Barry Weiss from the Department of Family and Community Medicine at the University of Arizona, College of Medicine.
More information about the PHCRED Tri-State Program is available at <http://www.phcredtristate.org.au>
VICPHCRED
Anna Chapman
VicPHCRED Statewide Coordinator
P: +61 3 8575 2246
E: anna.chapman@med.monash.edu.au
In May, the University of Melbourne, School of Rural Health (SRH) in Shepparton welcomed Victorian PHCRED fellows to attend workshops on qualitative and quantitative research theories and techniques
PHCRED Fellows from Monash University Department of Rural & Indigenous Health, Monash University Department of General Practice (DGP), the University of Melbourne DGP and the University of Melbourne SRH were involved in the day long excursion. This was the first chance for all Victorian PHCRED fellows to come together as a group and it proved to be a great networking and research capacity building experience for everyone involved. It also gave the fellows from metropolitan Melbourne an opportunity to visit a regional university campus and meet its staff
The excursion featured A/Prof Julie Pallant, Director of Research and Graduate Studies at the University of Melbourne SRH, who gave the fellows a comprehensive introduction to quantitative research methods and theories. In addition to this, Dr Victoria Palmer, an applied ethicist from the University of Melbourne DGP conducted an interactive session on qualitative research. The experience was beneficial for all fellows who will continue to build positive relationships from this and also support each other and their research.
The next Victorian PHCRED excursion will be hosted by the Monash University Department of Rural & Indigenous Health in Moe and will cover the issues and implications for rural and indigenous health research.
COMBINED UNIVERSITIES CENTRE FOR RURAL HEALTH
Lyn Brun
Statewide PHCRED WA Coordinator
P: +61 8 9956 0200
E: lynb@cucrh.uwa.edu.au
PHCRED WA has produced a brochure which promotes and highlights the current research being undertaken across the state. It incorporates all three Western Australian departments: The University of Western Australia, the University of Notre Dame Australia and the Combined Universities Centre for Rural Health.
The University of Western Australia is involved in four cancer related studies:
- BEST Australian study – Barrett’s Oesophagus Screening Trial.
- RCO Rural Cancer Study – Improving Rural Cancer Outcomes.
- PC4 - Primary Care Collaborative Cancer Trials Group.
- FAST study collaboration with Cambridge University – family history screening tool for use in tailored preventative advice for certain cancers, ischemic heart disease and diabetes.
Combined Universities Centre for Rural Health delivers research excellence in rural, remote and Aboriginal primary health care. CUCRH is undertaking research in the following fields:
- Prevention and management strategies for chronic diseases such as diabetes and asthma.
- ulturally secure ear health and maternal care for Aboriginal people.
- eHealth solutions to increase access.
- Allied health workforce solutions.
University of Notre Dame is involved in various research projects including:
- Fremantle Primary Prevention Study into risk factor modification for cardiovascular disease.
- Chlamydia screening study in young men attending GP practices.
- GP workforce continuum from career aspirations of medical students to Registrar work intentions and retirement intentions of GPs aged 45-65.
- Multimorbidity in general practice.
or copies of the brochure contact Lyn on
P: +61 8 9956 0200
E: lynb@cucrh.uwa.edu.au
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