Kate Freire

Being active benefits children and their parents, but there is a lack of co-designed resources that support families to engage in physical activity (PA) together. This exploratory co-design study aimed to identify ways to optimize guidance resources intended to assist in being active together, and to evaluate the co-design approach it used. Physiotherapist-researchers with experience and expertise in family PA drafted 2 evidence-informed prototypes. One prototype informed families about the holistic benefits of being active together, while the other helped families to plan their episode of PA. Twelve parents from 9 rural families and their neurodiverse or developmentally diverse children (n=13) were recruited as co-designers to ensure a wide range of considerations. Family co-designers took part in 2 to 3 workshops. They trialed the prototypes, telling researchers what worked well and how to improve them. Child and adult advisory groups oversaw the co-design approach. Each group met 3 times, with the child advisory group meeting prior to the adult advisory group. A child voice facilitator and advocate was used to support the child advisory groups and facilitate communication between child and adult advisory groups. Sixty-two changes were made to the prototypes in response to feedback from families and researcher observations. Key changes to resources recommended by children, parents, and researchers to increase user acceptability and usability included changing the ordering of the planning resource to reflect the way that most families used it, adding a "hard words" section to improve readability, support to normalize that no-one wins all the time, additional examples to cover each section of the resources, and encourage negotiation among families to ensure that the planned PA was mutually desirable. All families used the resources to successfully complete, or adapt, their planned session of PA together. Overall, co-designers and advisory group members perceived the co-design approach to be appropriate and responsive. However, the researchers identified a possible gap in final communication with the children regarding dissemination of results of the project which were provided to families via parents' email. The co-design approach used in this study supported families, including neurodiverse and developmentally diverse children, to trial and provide feedback on PA resources. The large number of changes made to the resources from co-designer suggestions and researcher observations highlights the importance of gaining user feedback for consumer resources. Future research is needed to evaluate how these co-designed resources may impact family PA behavior and identity. The transparent co-design approach and evaluation highlighted limitations for research communication to children, which require careful consideration in future similar studies.

Background: Rising global temperatures and increased use of personal protective equipment has led to increased risk of heat stress amongst healthcare professionals. This review synthesizes recent research on the impact of heat and heat mitigation strategies on healthcare professionals across disciplines and settings.Method: Databases were systematically searched using keywords and data from included studies were extracted for content analysis.Results: Among 15 eligible studies, 13 investigated the impact of heat stress on healthcare professionals. Six investigated mitigation strategies. Most studies utilized survey methodology and were related to the use of personal protective equipment during the recent pandemic. Large proportions of healthcare professionals reported high levels of thermal discomfort and preferred a cooler temperature in the workplace. The most commonly reported heat strain symptoms included sweating, fatigue, thirst, and poor or reduced concentration. Investigation of mitigation strategies has thus far focused on individual strategies with little insights gained into organizational support or heat policy.Conclusions: Supporting healthcare professionals to manage the impact of heat stress has received little attention in the literature. Mitigation strategies have thus far focused predominantly upon individual strategies. Future studies should adopt a more comprehensive approach to investigating healthcare professional's experiences, investigating all levels of controls.

Exercise interventions are identified as effective treatments for children not meeting developmental milestones. This systematic review synthesizes research regarding exercise interventions that involved social participatory elements, for children with complex developmental needs. Academic Search Complete, CINAHL, Emcare, Proquest Theses and Dissertations, MEDLINE, and Google Scholar were searched systematically for relevant studies. Peer-reviewed studies meeting the review aim and published between 2000 and 2021 in English, were included. Methodological quality of 49 eligible studies (47 controlled trials, two mixed methods, total of 2355 participants) was appraised using the Mixed Methods Appraisal Tool. Narrative synthesis identified two groups of studies: Group 1 incorporated intentional social participatory elements; Group 2 likely involved incidental social participation. Most studies were of moderate to low methodological quality. Few measured impacts of interventions upon total physical activity levels. Short-term improvements in physical outcomes – particularly motor skills – were most frequently reported and were the main benefit of social exercise interventions for children with complex developmental needs, for which evidence exists. Further rigorous, longitudinal research is needed to assess social, psychological, and executive function outcomes of social exercise interventions in this population. Such interventions should incorporate booster sessions to provide children with greater opportunity to meet developmental milestones.

Background: Despite increasing numbers of women serving in defence forces worldwide, little is currently known about how servicewomen manage their pelvic health in the traditionally male environment of the military. Objectives: The aim of this study was to explore the impacts of pelvic health issues on Australian Defence Force servicewomen and their experiences of managing their pelvic health in occupational settings. Design: A qualitative hermeneutic design. Methods: Telephone interviews were conducted on six currently serving female members of the Australian Defence Force located Australia-wide. A semi-structured interview guide, based on the study objectives, was used to guide the audio-recorded interviews. Data were analysed thematically. Results: Nine themes were identified. The first six themes explored the experiences of servicewomen in maintaining their pelvic health, including suppressing the urge to go, adjusting hydration depending on toilet access, managing menstruation, regaining ‘full’ fitness postpartum, awareness and prevention of pelvic health conditions, and inhibiting conversations about women’s health. The last three themes explored how servicewomen coped with pelvic health conditions, including self-managing symptoms, diagnosing and treating pelvic conditions, and support for servicewomen’s pelvic health. Conclusion: This study suggests workplace culture, low levels of insight into pelvic health norms, and limited healthcare strategies within the Australian Defence Force to support female pelvic health have contributed to servicewomen self-managing pelvic health issues using approaches that may have had significant impacts on their health and well-being.

Introduction: The use of telehealth has accelerated with health service delivery restrictions experienced during the COVID-19 pandemic. This research assessed learner enrolments and feedback in an introductory, online, open-access, rural-focused telehealth training course to inform future telehealth education design. Methods: Differences in enrolled learner demographics “before” (n = 331) and “after” (n = 3,776) COVID-19-related changes in Australia were assessed. Content analysis of learner feedback was conducted to understand the beneficial aspects of the course and to inform future telehealth education and training development. Results: Concurrent with telehealth changes announced in Australia in March 2020, enrolments in the course sharply increased. While students comprised most enrolments, initial growth was strongest amongst health educators and health professionals. More learners enrolled from major city areas and other countries. User feedback indicated the flexible delivery mode, policy, links to resources and multimedia content were the most beneficial aspects of the course. Learners would like more client perspectives as well as discipline- and context-specific information. There is also an appetite for more practice-based telehealth education. Conclusions: Growth in demand for the course and positive learner feedback showed it was filling an important introductory training gap. Learner feedback also highlighted several perceived barriers among learners in being able to implement best-practice telehealth in their current or future practice. This feedback could be used to inform the design of further telehealth training for health professionals and students to, ultimately, enhance the use of telehealth technologies.

First Nations peoples in Australia are disproportionately affected by diabetes. We report on a qualitative evaluation of a healthy lifestyle group programme at an Aboriginal Community Controlled Health Service. The programme was designed by an Aboriginal Health Worker and took place in a regional community. Yarning interviews of five participants and four facilitators were conducted followed by a collaborative analysis. The group context provided connecting and relationship-building opportunities, allowing participants to feel that they were seen as an individual. The accidental hybrid approach adopted due to the impact of COVID-19 pandemic lockdown supported transition of healthy activities into the home context while still accessing support and motivation from the group. This paper concluded that the unintentional hybrid programme found promising individual and cross-generational health and wellbeing benefits for First Nations families which suggests that intentional hybrid frameworks may show promise in improving First Nations peoples’ health and well-being.

Introduction and hypothesis: Lower urinary tract symptoms (LUTS) are common in the general female population. It was hypothesised that Australian female military personnel and veterans would experience similar types and prevalence of LUTS as the broader Australian female population. Methods: An online cross-sectional survey was utilised to explore the pelvic health of active servicewomen and veterans in the Australian Defence Force (ADF). For the purposes of this report, only the demographic and LUTS data (excluding urinary tract infections) were extracted and descriptively analysed. Results: A total of 491 complete survey responses were received and analysed. Respondent characteristics were comparable to those documented in a departmental report regarding ADF servicewomen. No LUTS were reported by 38% of respondents. Regular symptoms of urinary incontinence were experienced by 27% of respondents (stress urinary incontinence = 23%, urge urinary incontinence = 16%, mixed urinary incontinence = 13%), bladder storage issues by 20–27%, and various voiding impairments by 9–27%. In addition, 41% reported regularly experiencing two or more LUTS, and for over two thirds of respondents, LUTS were an ongoing issue. Relationships between age, parity, and symptoms of urinary incontinence were also seen. Conclusions: Consistent with wider research in Australian female populations, LUTS were commonly experienced during service by ADF female military personnel and veterans. Given the high likelihood of female military personnel experiencing LUTS during their service, and a proportion experiencing ongoing symptoms, tailored monitoring and support for urinary health should be available to enhance occupational health, safety, and performance.

Background: Supporting the provision of clinical placement (CP) experiences in rural areas is a strategy used worldwide to promote the rural health workforce. While there is international evidence for this intervention in medicine, there is limited understanding of the influence of rural CP for nursing, midwifery, allied health, and dentistry health professions in Australia, which have received substantial federal investment. This review examined the relationship between rural CP and non-medicine health students’ future rural practice intentions and workforce outcomes. Methods: Four databases were systematically searched; papers were screened using defined criteria and appraised using the mixed-methods appraisal tool (MMAT). Findings were synthesized using a critical narrative approach. Results: The methodological quality of the 29 eligible studies (13 quantitative non-randomized, 10 mixed method, 4 qualitative, 2 quantitative description) was appraised. Ten high-quality studies were identified. The review found that positive CP experiences may influence intention to practice rurally amongst undecided students and serve as a reinforcing experience for those students already interested in rural practice. There were mixed findings regarding the influence of CP length. The review also found that there is currently only evidence for the short-term effects of CP on students’ future practice outcomes in rural areas with focus thus far on early practice outcomes. Conclusions: Those looking to use rural CP to promote the rural health workforce should focus on supporting the quality of a large number of CP experiences that are undertaken in rural areas, as there are currently differing findings on the role of rural CP length. Future studies of rural CP should consider greater use of social and educational theories to guide them.

In research, participatory approaches involve engaging in the research with people and empower co-researchers to have a voice. The aim of this review was to synthesize the methods and approaches used to enable children, adolescents, and families to be involved in a participatory approach in research conducted to inform development of health resources and interventions aimed at children and adolescents. Key databases were searched systematically using key word and subject heading searches and included studies were appraised for both methodological quality and sufficiency of reporting of their participatory approach. Findings were synthesized using a critical narrative approach. Among 26 eligible studies, commonly reported participatory approaches involved community-based participatory research, codesign, participatory design, coproduction, and user-centred design. A need was identified to involve co-researchers more in the later stages of participatory approaches. Most studies were of low to moderate methodological quality. A wide variety of methods and activities were used in the studies to enable children to participate in the research, but few studies provided sufficient evidence of their participatory approach. This review concludes that reporting of participatory approaches might benefit from the guidelines that acknowledge the dual nature of participatory approaches as both a research method and an approach that enables action and change.