The foster care system in Victoria, Australia, faces a critical challenge with a declining number of foster carers amidst an increasing demand for placements. This research aimed to identify the perceived benefits of using tailored recruitment strategies for foster carer recruitment and the key characteristics of those inclined toward foster care. Eight representatives from Victorian foster care agencies participated in semi-structured interviews, followed by an online survey completed by 1033 Victorian adults. Tailored recruitment efforts for both messaging and targeting of audiences were deemed crucial and effective by interviewees. Cluster analysis of the survey results revealed two distinct groups, with the fostering-inclined group comprising 31% of the sample and more likely to be female, aged 21-55, working in a care- or social-oriented profession, and have a spare room. Implications of sociodemographic, attitudinal, and behavioral characteristics associated with considering fostering are discussed in relation to designing targeted recruitment campaigns. This study highlights the importance of tailored recruitment for foster carers and provides practical directions for foster care agencies to identify and engage relevant audiences more inclined to consider fostering.

This article explores how the design and delivery of programs challenging gendered norms amongst men and boys can support attitude and behaviour change through more conscious and deliberate engagement with program content. Sixty-seven past participants of programs delivered by five Australian organisations completed an online survey based on their experiences. The Elaboration Likelihood Model (ELM) was used to explore participants' perspectives regarding motivation and ability to elaborate on program content, evidence of elaboration occurring, and experiences of attitude and behaviour change post-program. Program strengths included highlighting the personal relevance of program content, eliminating distractions and message comprehensibility. Opportunities for improvement included increasing message repetition and the number of message sources. Evidence of elaboration was present across all program types, including single-session programs, and included reflections on social and emotional learnings. The findings demonstrate how program design and delivery can support processing program material at a deeper and more conscious level, including when dealing with resource and time constraints.

Objective: This study aimed to evaluate a behaviour change strategy to enhance the patient voice in the early post-operative setting. Methods: The Patient Power notepad was evaluated in an uncontrolled, single-group, mixed-methods trial including a patient evaluation survey and staff phone interviews. Results: Patients thought that the notepad was well-designed and prompted them to think of and ask questions. They strongly agreed that healthcare practitioners answered health-related questions fully and carefully. Staff reported that the notepad not only provided an easy mechanism through which patients and their families could communicate with their healthcare team, but it also created a permissive environment where questions were encouraged. Conclusion: The Patient Power notepad provided an easy, acceptable and scalable intervention to encourage patients to engage more in their healthcare and specifically to ask questions about their care. By providing a structured tool for capturing patient concerns, symptoms, and questions, this innovation holds the potential to enhance patient satisfaction, treatment adherence, and overall healthcare outcomes. Innovation: By facilitating comprehensive information exchange and the potential to promote shared decision-making, this innovation has the potential to improve patient satisfaction, treatment adherence, and overall healthcare outcomes.

INTRODUCTION:Patients who present to hospital with an acute non-critical illness or injury, which is considered outside the capability framework of that hospital to treat, will require inter-hospital transfer (IHT) to a hospital with a higher level of capability for that condition. Delays in IHT can negatively impact patient care and patient outcomes.OBJECTIVE:To review and synthesis academic evidence, practitioner insights and patient perspectives on ways to improve IHT from regional to metro hospitals.DESIGN:A rapid review methodology identified one review and 14 primary studies. Twelve practitioner interviews identified insights into practice and implementation, and the patient perspectives were explored through a citizen panel with 15 participants.FINDINGS:The rapid review found evidence relating to clinician and patient decision factors, protocols, communication practices and telemedicine. Practitioner interviews revealed challenges in making the initial decision, determining appropriate destinations and dealing with pushback. Adequate support and communication were raised as important to improve IHT. The citizen panel found that the main concern with IHT was delays. Citizen panel participants suggested dedicated transfer teams, education and information transfer systems to improve IHT.DISCUSSION AND CONCLUSION:Common challenges in IHT include making the initial decision to transfer and communicating with other health services and patients and families. In identifying the appropriateness of transferring acute non-critical patients, clear and effective communication is central to appropriate and timely IHT; this evidence review indicates that education, protocols and information management could make IHT processes smoother.

OBJECTIVES:This study was aimed at understanding the attitudes and positions of key Australian organisational and political stakeholders towards using psychedelic agents in medically supervised environments to treat mental health conditions. Specifically, this research was designed to identify some of the issues that might impede the clinical implementation of psychedelics.METHODS:Semi-structured interviews were conducted with four Australian politicians and nine representatives of key stakeholder organisations between September 2022 and January 2023. Data analyses were completed using pattern-based inductive thematic analysis.RESULTS:Participants were cautiously optimistic about using psychedelics to treat mental health conditions, with hesitancy emerging due to the perceived inadequacy of research into the efficacy and feasibility of these treatments. Politicians consistently mentioned that negative stigma prevented them and their peers from supporting the use of psychedelics in Australia. Effective, evidence-based, clear messaging that refutes misconceptions, uses persuasive messaging and provides clear information to inform implementation is needed to improve knowledge and challenge attitudes, biases and emotions that can influence the debate around psychedelics.CONCLUSIONS:Stakeholder representatives and politicians agree that insufficient evidence exists to support the widespread clinical implementation of psychedelics in Australia. Politicians also perceive the stigma associated with psychedelics might negatively influence progressive legislation. Additional research and a clear presentation of this research are needed before the clinical use of psychedelics can be supported.

Background: Nurses and junior doctors are often the first clinicians to recognise signs of deterioration in patients. However, there can be barriers to having conversations about escalation of care.Objectives: The aim of this study was to study the frequency and nature of barriers encountered during discussions related to escalation of care for deteriorating hospitalised patients.Methods: This was a prospective observational study with daily experience sampling surveys related to escalation of care discussions. The study setting involved two teaching hospitals in Victoria, Australia. Consented doctors, nurses, and allied health staff members involved in routine care of adult ward patients participated in the study. The main outcome measures included the frequency of escalation conversations and the frequency and nature of barriers encountered during such conversations.Results/Findings: 31 clinicians participated in the study and completed an experience sampling survey 294 times, mean (standard deviation) 1/4 9.48 (5.82). On 166 (56.6%) days, staff members were on clinical duties, and escalation of care discussions occurred on 67 of 166 (40.4%) of these days. Barriers to escalation of care occurred in 25 of 67 (37.3%) of discussions and most frequently involved lack of staff availability (14.9%), perceived stress in the contacted staff member (14.9%), perceptions of criticism (9.0%), being dismissed (7.5%), or indication of lack of clinical appropriateness in the response (6.0%).Conclusions: Discussions related to escalation of care by ward clinicians occur in almost half of clinical days and are associated with barriers in one-third of discussions. Interventions are needed to clarify roles and responsibilities and outline behavioural expectations on both sides of the conversation and enable respectful communication amongst individuals involved in discussions of escalation of patient care.(c) 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

The policy orientations of advanced neoliberal democracies situate young people as rational actors who are responsible for their own career outcomes. While career scholars have been critical of how this routinely ignores the unequal effects of structural constraints on personal agency, they have long suggested that young people should have access to the best available ‘roadmaps’ and advice to navigate the uncertainties baked into the contemporary economic landscape. Complementing the significant attention that is given to the (potentially emancipatory) experience of formal careers guidance, we present findings from a multi-method study. We explore young Australians’ (aged 15–24) navigation of careers information through a nationally representative survey (n = 1103), focus groups with 90 participants and an analysis of 15,227 social media comments. We suggest that the variety of formal and informal sources pursued and accessed by young people forms a relational ‘ecology’. This relationality is twofold. First, information is often sequential, and engagements with one source can inform the experience or pursuit of another. Second, navigation of the ecology is marked by a high level of intersubjectivity through interpersonal support networks including peers, family and formal service provision. These insights trouble a widespread, but perhaps simplistic, reading of young people having largely internalised a neoliberal sensibility of ‘entrepreneurial selfhood’ in their active pursuit of a range of career advice. Throughout our analysis, we attend to the ways that engagement in the career information ecology is shaped by social inequalities, further underscoring challenges facing careers guidance and social justice goals.

Traumatic brain injury (TBI) continues to substantially impact the lives of millions of people around the world annually. Community-based prevention and support of TBI are particularly challenging and underresearched aspects of TBI management. Ongoing cognitive, emotional, and other effects of TBI are not immediately obvious in community settings such as schools, workplaces, sporting clubs, aged care facilities, and support agencies providing homelessness or domestic violence support. This is compounded by a lack of guidance and support materials designed for nonmedical settings. Connectivity Australia, a not-for-profit organization promoting TBI awareness, research, and support, responded to this need by conducting a national survey and series of roundtables to deepen understanding of TBI awareness, challenges, and support needs across the community. The 48 survey respondents and 22 roundtable participants represented Australian departments of health; correctional services; homelessness and housing; Aboriginal and Torres Strait Islander health; community, school, and professional sports; allied healthcare and rehabilitation providers; insurance; and work health and safety. Three key themes were identified: Accessible, nationally consistent plain-language guidelines; Building research literacy; and Knowing your role in TBI identification and management. This commentary briefly describes these themes and their implications based on a publicly available full report detailing the study findings(www.connectivity.org.au/resources-for-researchers/connectivity-research).

Programs working with men and boys in relation to gender equality are increasing. Little is known, however, about how these programs go beyond raising awareness, to supporting attitude and behaviour change in their participants. In response, 17 facilitators from eight Australian organisations were interviewed to identify program design and delivery strategies that increase male participants’ engagement. Analysis of interview data revealed three themes and seven subthemes, which were crosschecked against survey data from 79 program participants. The themes were the provision of a safe, judgement-free environment; encouraging and supporting growth in participants; and the central role of the facilitators in the success of the first two themes, and in the delivery of programs more generally. Facilitator and participants held mostly consistent perspectives, which were comparable with the existing literature; variations from the literature were noted, however, regarding the lack of efficacy of single-session programs and the relevance of facilitator gender.

Objectives: Providing accurate and timely diagnoses is challenging in ED settings. We evaluated the feasibility and effectiveness of a short, structured rapid diagnosis discussion (RaDD) between a patient's initial doctor and a second doctor for patients presenting to ED with abdominal pain.Methods: Controlled pre-post, mixed-methods pilot study in a metropolitan hospital network in Melbourne, Australia. Comparisons were made between an ED using RaDD for a 1-month period (n = 155) and two control EDs within the same hospital network (n = 2227) using standard practices. A short survey of 27 clinicians was also undertaken.Results: Provisional diagnoses changed in 24.7% (95% confidence interval 19.0, 30.4) of all cases for which a RaDD case report sheet was completed, and clinicians' confidence in their decision-making was significantly higher when using RaDD (r = 0.27). RaDD significantly increased the likelihood that patients would be sent to the short stay unit and have a blood test ordered, and significantly reduced the likelihood that patients would be discharged home from the ED or leave at their own risk. Usage of the RaDD tool was low (25.2% of eligible cases), and qualitative feedback indicated that time limitations inhibited uptake.Conclusions: RaDD encouraged clinicians to take a more cautious, risk-averse approach to care and improved confidence in their diagnostic decisions. However, cost effectiveness of these outcomes and possible implementation barriers need to be further considered in subsequent studies.

This Evidence Check was commissioned by the NSW Ministry of Health, as part of a project to improve how preventive, sensitive health issues are raised in general practice. The review looked at what is known about discussing sensitive preventive health issues from both patients and GPs perspectives and approaches and factors that have been shown to be effective. The identified evidence was generally of moderate to high methodological quality. General behaviour change approaches that are applicable to this challenge include creating non-judgemental environments that normalise sensitive health issues; simulation training; and public campaigns that reduce stigma and challenge unhelpful cultural norms. Lack of time in consultations was identified as a challenging issue. Significant system-level change would be required to extend standard consultation times; focusing on optimising workflows may therefore be more feasible. Addressing GP patient–gender mismatch through diverse GP representation may also be feasible in larger practices. The key theme identified was the use of prompting, screening or other structured tools by GPs. Collectively, these approaches have two main features. First, they are a way of approaching sensitive health conversations less directly, for example by focusing on underlying risk factors for sensitive health conditions such as obesity and mental illness rather than addressing the issues directly. Second, through either risk-factor or more general question prompts, these approaches take the onus away from GPs and patients to come up with a way of asking the question using their own words.

Objective To identify behavioural drivers and barriers that may have contributed to changes in ED attendance during the first 10 months of the coronavirus disease 2019 (COVID-19) pandemic in Victoria. Methods We conducted a mixed methods analysis of patients who attended one of eight participating EDs between 1 November 2019 and 31 December 2020. A random sample of patients were chosen after their visit and invited to participate in an online survey assessing behavioural drivers and barriers to attendance. The study timespan was divided into four periods based on local and world events to assess changes in attitudes and behaviours over this period. Results A total of 5600 patients were invited to complete the survey and 606 (11%) submitted sufficient information for analysis. There were significant differences in participants' attitudes towards healthcare and EDs, levels of concern about contracting and spreading COVID-19 and the influence of mask wearing. Patients expressed more concern about the safety of an ED during the largest outbreak of COVID-19 infections than they did pre-COVID, but this difference was not sustained once community infection numbers dropped. General concerns about hospital attendance were higher after COVID than they were pre-COVID. A total of 27% of patients specifically stated that they had delayed their ED attendance. Conclusion Patients expressed increased concerns around attending ED during the first 10 months of the 2020 COVID-19 pandemic and frequently cited COVID-19 as a reason for delaying their presentation. These factors would be amenable to mitigation via focussed public health messaging.

Abstract Background Meaningful involvement of consumers in healthcare is a high priority worldwide. In Victoria, Australia, a Partnering in Healthcare (PiH) policy framework was developed to guide health services in addressing consumer-focused healthcare improvements. The aim of this project was to identify priorities for improvement relating to the framework from the perspective of Victorian healthcare consumers and those who work in the healthcare sector. Methods A survey of Victorians representing key stakeholder groups was used to identify a “long list” of potential priorities, followed by a day-long summit to reduce this to a “short list” using explicit prioritization criteria. The survey was piloted prior to implementation, and diverse consumer groups and key health service providers were purposefully sampled for the summit. Results The survey (n = 680 respondents) generated 14–20 thematic categories across the proposed framework’s five domains. The summit (n = 31 participants, including n = 21 consumer representatives) prioritized the following five areas based on the survey findings: communication, shared decision-making, (shared) care planning, health (system) literacy and people (not) around the patient. These priorities were underpinned by three cross-cutting principles: care/compassion/respect, accountability and diversity. Conclusion Few studies have explicitly sought consumer input on health policy implementation. Adopting a codesign approach enabled the framework to be a shared foundation of healthcare improvement. The framework was subsequently launched in 2019. All Victorian health services are required to commit annually to improvement priorities against at least two framework domains.

Polycystic ovary syndrome (PCOS) is the most common endocrinological disorder affecting women of reproductive age, affecting 8-13% in this group. Women with PCOS are more likely to have excess BMI, which in turn exacerbates the symptoms of PCOS in these women. The latest evidence-based guideline recommends lifestyle management as the first-line treatment for PCOS. However, the implementation of this recommendation through health services faces a significant challenge. As part of the mapping of the implementation plan for lifestyle management in PCOS, citizen panels and semi-structured interviews were conducted to capture the voices of consumers. Women with PCOS expressed the need for multidisciplinary, integrated care as a recurrent theme. Other important considerations included health professionals who listen and are open to learning about PCOS, the empowerment of women to self-manage PCOS and the provision of peer support. Women with PCOS also expressed the key recommendation of focusing on practical skills when providing lifestyle advice. Within that, both individual and group lifestyle sessions were valued for privacy and peer support respectively and delivery by a dietitian is preferred. These recommendations by women with PCOS should be considered when developing the implementation plan for the PCOS lifestyle guideline.

In Chapter 7, we covered different research methods to engage with our target audience and understand their behavioural influences. Now that you have gathered your audience insights, how do you turn this into an effective behaviour change intervention? How do you avoid the common pitfalls of defaulting to the same old interventions, relying on preconceived notions of what works, and failing to heed the advice of key stakeholders?In Chapter 8, we learn how to match behavioural influences to intervention options, prioritise interventions, and carry out an intervention co-design. All of these steps will help you develop an intervention that maximises the chance of changing your target behaviour.

Why should we consult with stakeholders? What can they tell us that a good data set or academic paper can't? Find out in this Chapter why talking to people is important and how it can improve research, programs and policies.

In the face of ongoing attempts to achieve gender equality, there is increasing focus on the need to address outdated and detrimental gendered stereotypes and norms, to support societal and cultural change through individual attitudinal and behaviour change. This article systematically reviews interventions aiming to address gendered stereotypes and norms across several outcomes of gender inequality such as violence against women and sexual and reproductive health, to draw out common theory and practice and identify success factors. Three databases were searched; ProQuest Central, PsycINFO and Web of Science. Articles were included if they used established public health interventions types (direct participation programs, community mobilisation or strengthening, organisational or workforce development, communications, social marketing and social media, advocacy, legislative or policy reform) to shift attitudes and/or behaviour in relation to rigid gender stereotypes and norms. A total of 71 studies were included addressing norms and/or stereotypes across a range of intervention types and gender inequality outcomes, 55 of which reported statistically significant or mixed outcomes. The implicit theory of change in most studies was to change participants' attitudes by increasing their knowledge/awareness of gendered stereotypes or norms. Five additional strategies were identified that appear to strengthen intervention impact; peer engagement, addressing multiple levels of the ecological framework, developing agents of change, modelling/role models and co-design of interventions with participants or target populations. Consideration of cohort sex, length of intervention (multi-session vs single-session) and need for follow up data collection were all identified as factors influencing success. When it comes to engaging men and boys in particular, interventions with greater success include interactive learning, co-design and peer leadership. Several recommendations are made for program design, including that practitioners need to be cognisant of breaking down stereotypes amongst men (not just between genders) and the avoidance of reinforcing outdated stereotypes and norms inadvertently.

To understand the role of symptom attribution in treatment-seeking behaviours, survey results of 1356 veterans (age = 38–72 years) were analysed. Controlling for symptom frequency, significant relationships were found for specialist and psychological-related consultations. Those who favoured psychological explanations for symptoms were more likely to attend specialist and psychology-related consultations and filled significantly more prescriptions than people who predominantly explained symptoms by situational factors (normalisers). Veterans who favoured somatic explanations attended more general practitioner consultations than normalisers. Attributional style should be considered part of the constellation of factors influencing healthcare usage. Normalisers, the predominant group, used fewest health services and filled fewest prescriptions; this may have important implications for healthcare considering their tendency to minimise or downplay symptoms.