Melinda Toomey

Context: Using communication tactics and reducing background noise are key staff behaviours to improve communication with long-term care residents, a population with high levels of hearing loss. Objectives: To identify barriers and enablers to these behaviours in long-term care settings. Methods: Semi-structured interviews were conducted with 23 staff who provide day-to-day care for residents in a long-term care home in Australia. Data were analysed using a hybrid approach, combining deductive thematic analysis based on the Capability, Opportunity, and Motivation model of Behaviour (COM-B), with inductive thematic analysis. Findings: Analysis identified multi-level barriers and enablers influencing aged care staff use of communication tactics and strategies to reduce background noise when interacting with residents. Key barriers included limited knowledge of residents’ communication needs and hearing status, variable awareness of the impact of background noise, difficulties adapting communication during busy periods, time and staffing constraints, unclear organisational protocols, environmental challenges, and communication difficulties associated with dementia and behavioural symptoms. Despite these challenges, staff were generally motivated to support effective communication and recognised its benefits for resident well-being, relationships, and care delivery. Important enablers included supportive managers and colleagues, staff experience and communication skills developed through practice, collaboration with families, access to communication-related information in care plans, visual prompts and cues, and positive beliefs about the benefits of communication strategies and noise reduction. Staff also reported that effective communication improved resident cooperation, reduced distress, enhanced social interaction, and increased job satisfaction. Limitations: This study was conducted at two long-term care communities within a single care provider in Australia, which may limit the transferability of our findings to other settings. Implications: These findings could inform multi-component interventions combining targeted training, clear communication policies, environmental adjustments, and ongoing organisational support that are required to enhance staff communication practices, improve communication with residents, foster meaningful social interaction, improve care delivery, improve residents’ mental health and quality of life, and create a supportive work environment.

The ageing process is commonly accompanied by sensory impairments,1 with vision and hearing impairment among the most prevalent. Hearing impairment is particularly common, affecting a substantial p...

Background: Hearing, vision and cognitive impairments are common yet frequently underrecognized among older adults. Although these impairments affect quality of life, functional independence and psychological well‐being, there are no published data on the prevalence and consequences of these impairments in relation to Australian home care populations. This protocol outlines a cross‐sectional investigation into the prevalence of hearing, vision and cognitive impairments and their associations with quality of life, functional ability and psychosocial well‐being among older Australians receiving home care services. Methods: A total of 369 participants aged 65 years and older will be recruited from home care services across Australia. Standardized assessment tools will be used to assess hearing, vision and cognitive function, quality of life, daily living activities, mental health and social participation. Multi‐variable regression models will explore the impact of sensory and cognitive impairments on health and well‐being outcomes. Discussion: With ageing populations, it is increasingly important to support older people to live independently in their own homes rather than needing to move into residential aged care. This study will facilitate understanding of the prevalence and impact of sensory and cognitive impairments among the older Australian home care population. Findings may inform strategies to support health ageing in place, including service planning, care coordination and workforce training. Patient or Public Contribution: Older adults receiving home care services and individuals with lived experience of sensory and cognitive impairments contributed to the study design. A Patient and Public Involvement advisory group and a stakeholder steering group will guide study implementation.

Background and Aims: Hearing and vision impairments are prevalent health conditions among older adults, negatively affecting functional ability, mental and social well‐being, quality of life and increasing the likelihood of transition to long‐term care. Sensory impairments are also common comorbidities with dementia, compounding the impact of dementia. Early intervention to optimize sensory function may help older adults stay in their homes longer. The Australian government's ‘Homecare Package’ provides affordable care services to support older adults with complex needs at home; however, there is a lack of support for hearing and vision needs. This trial will investigate whether a sensory support intervention enhances the quality of life and other outcomes for older adults (aged 65 years or older) with diverse cognitive abilities and hearing and/or vision impairments, as well as their care partners. Methods: This manuscript presents a study protocol for a home‐based sensory support intervention for older adults with hearing and/or vision impairment who receive home care services. A pre‐post study will determine the impact and cost‐effectiveness of a 12‐week intervention. Key outcome measures include health‐related quality of life, sensory and cognitive functional ability, relationships, mental well‐being and health resource utilization. All outcomes will be assessed before the intervention (baseline) and 13‐ and 26‐weeks post‐intervention commencement. Conclusion: This manuscript describes the protocol for a pre‐post intervention trial. A parallel and complementary process evaluation will be detailed in a separate publication. If effective, the intervention may assist older adults to improve their quality of life and remain living in their own homes. Findings will generate evidence for hearing and vision support as part of home care services. Trial registration: ACTRN12624001167550 retrospectively registered.

Effective paediatric eyecare requires up-to-date knowledge and skills. Effective tele-mentoring and continuous education can significantly improve clinical confidence and ensure comprehensive care for paediatric patients. Project ECHO (Extension for Community Healthcare Outcomes) is a proven interactive case-based tele-mentoring for medical practitioners. A Paediatric Eyecare ECHO was implemented with Australian optometrists to evaluate its acceptability as an education modality and impact on self-reported confidence in clinical knowledge and competency. Eight weekly, hour-long ECHO sessions on paediatric eyecare topics, informed by a learning needs assessment survey, were conducted. Each session included a brief didactic lecture by an expert, case presentations by participating optometrists and interactive discussions. Participant engagement, satisfaction, likeliness to implement knowledge, and competence were evaluated. Online questionnaires (5-point scale) with open-ended questions were administered before, during, and after the programme. Quantitative data were analysed descriptively and inferentially, while qualitative data were thematically analysed. Fifty-four optometrists registered for the ECHO with 98.1% attending at least one ECHO session. Forty-four of 54 ECHO programme registrants participated in the programme evaluation. Initial self-reported competencies showed knowledge deficits (score 85%) and were likely to implement knowledge gained (>88.6%). Competence ratings increased significantly by +0.51 (Z = 4.3, p < .001). Qualitative feedback highlighted an appreciation for case-based presentations but a desire for more detailed clinical management and vision therapy information. The Paediatric Eyecare ECHO showed positive outcomes for optometrists in respect of engagement, satisfaction, likeliness to implement knowledge and self-assessed competency in treating paediatric patients. In addition to paediatric eye care case management, this model holds promise for interactive education in other ocular conditions managed by optometrists.

This study investigated the impact of cognitive function on the administration of the hearTest automated hearing test in older adults. The relationship between Montreal Cognitive Assessment (MoCA) score and three hearTest metrics (false response rate, standard deviation of response time, and test duration) was analysed. A cross-sectional correlational design was used. Testing was conducted in participants' homes or retirement villages. One hundred and five older adults (aged 67-97 years) receiving home-based aged care with MoCA scores ranging between 5 (possible dementia) and 30 (healthy cognition). There was no relationship between MoCA score and false response rate (r = -0.12, CI = -0.42 to 0.06, p = 0.22) or standard deviation of response time (r = -0.11, CI = -0.33 to 0.04, p = 0.27). There was a moderate sized correlation between MoCA score and test duration (r = -0.31, CI = - 0.49 to - 0.15, p = 0.001), indicating longer test duration with lower MoCA scores. hearTest performance is not impacted by cognitive ability in a population of older adults that included people living with dementia. However, additional test time may be needed for hearTest administration for individuals with cognitive impairment.

Collaborative eye care, where the skills of health professionals are utilised to their maximum capability, enhances patient outcomes. Optometrists are highly skilled eye care practitioners and yet their involvement in collaborative care is relatively limited. The aim was to understand the barriers and enablers to optometrists working in collaborative eye care within Queensland and identify key factors that affect optometry involvement. A mixed-methods approach comprised three parts. A) Survey of optometrists working in Queensland asking for their opinion on collaborative eye care. B) Interviews with optometrists working in public hospitals in Queensland. C) Responses from both the survey and interviews were deductively coded to the Theoretical Domains Framework (TDF) to identify barriers and enablers to collaborative eye care. The survey included 21 Likert-scaled questions and 9 free-text questions. Structured interviews asked questions about working in a collaborative eye care environment, transcripts were downloaded and checked for accuracy. Key TDF domains were mapped to the Capability, Opportunity, Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) to identify potential intervention functions to support collaborative eye care. Survey responses were received from 41 optometrists and 10 interviews were conducted. The Likert section of the questionnaire demonstrated strong internal consistency (Cronbach's alpha = 0.837) and response variation to individual questions (Friedman Chi-Square = 233, p = 0.001). Key enablers included optometrists having strong professional networks, effective communication pathways, high confidence in clinical skills and proximity to specialist care. Collaboration was constrained by inadequate referral pathways, lack of recognition of the role of optometrists and inadequate remuneration. Identified intervention strategies include enhancing capability through mentorship, restructuring environments to include shared information platforms, appropriate renumeration, and professional development opportunities. Critical enablers and barriers to collaborative eye care amongst Queensland optometrists were identified. Addressing the lack of infrastructure, professional recognition, and financial incentives could strengthen collaborative practices.

Older adults with hearing and/or vision impairment often face challenges in accessing appropriate support within home care services. This study investigated the hearing and/or vision support care needs of older Australians receiving home care, and assessed whether these needs were met. Semi-structured interviews were conducted with 13 home care recipients (mean age 81.2 years, range 71-94) reporting hearing (n = 3), vision (n = 4) or dual sensory impairments (n = 6), and three family members. Interviews explored physical, psychological, and communication needs, healthcare system interactions, and support requirements. Data were analysed using Braun and Clarke's thematic analysis. Four themes were identified: (1) understanding individual circumstances is fundamental to personalised hearing and vision care, (2) importance of support networks, (3) enhancing device use and communication, and (4) maintaining home life and connection to community. Participants reported difficulties with device management, communication, and accessing appropriate care. The study revealed poor coordination between hearing/vision specialists and home care providers, alongside inadequate assessment and response to sensory needs within existing services. Older Australians with hearing and/or vision impairment have distinct practical and psychosocial support needs that are not consistently addressed in current home care services. Findings suggest the need for integrated sensory care assessments and improved coordination between hearing/vision professionals and home care providers.

Background: A field trial of a home‐delivered hearing and vision support intervention will assess its impact on the quality of life and well‐being of home care recipients with hearing and/or vision impairment and their care partners. Aims: This paper outlines the protocol for a process evaluation of the field trial. The process evaluation aims to identify discrepancies between expected and actual outcomes, understand contextual influences, assess implementation fidelity and evaluate the feasibility, appropriateness and acceptability of the intervention. Methods: Data will be collected from 87 home care recipients with hearing/vision impairment, their care partner and the sensory therapist who will deliver the intervention at multiple points during the 3‐month intervention. Likert‐scale ratings for feasibility, appropriateness and acceptability will be gathered. Proxy measures of fidelity, such as intervention session completion rates, will be obtained to ascertain whether the intervention was delivered as designed. Post‐intervention, 20% of participants will complete semi‐structured interviews to explore contextual and causal factors. Data analysis will include descriptive statistics, regression analysis and thematic qualitative analysis. Discussion: The process evaluation will elicit the perspectives of home care recipients and their care partners regarding the intervention experience. Patient or Public Contribution: Older adults with lived experience with dementia and hearing and/or vision will contribute to the proposed research by shaping the interview topic guide to ensure its appropriateness and relevance for the target population. Their insights will result in a more rigorous study and improve the likelihood of the final intervention meeting real‐world needs.

Purpose: The Queensland Children's Hospital Paediatric Optometry Alignment Program commenced with a pilot phase to assess its feasibility, effectiveness and acceptability. This study identified the barriers that hinder effective interprofessional collaboration and the facilitators that contribute to its success, and assessed changes in optometrists' satisfaction since the pilot phase of the collaborative care programme. Methods: Qualitative deductive and inductive content analysis was applied to open‐ended free‐text survey responses collected in 2018 from the optometrists involved in the Program's pilot phase. The responses were coded using the Theoretical Domains Framework (TDF) to categorise barriers and facilitators into key themes. Key behavioural determinants were mapped to the COM‐B (Capability, Opportunity, Motivation‐Behaviour) elements of the Behaviour Change Wheel model to identify intervention strategies. Intervention recommendations were derived from behaviour change mapping and compared with programme quality improvement initiatives. A cross‐sectional explanatory survey informed by the TDF was conducted within the current 2023 cohort, and a longitudinal comparative analysis was carried out using data from the 2018 survey. Results: Among the 97 surveys distributed in 2018, 44 respondents participated; from this group, 38 individuals contributed a total of 200 free‐text responses. Facilitators (240 comments) outnumbered barriers (65 comments). Key facilitators were accessible and timely care, professional development, confidence and positive outcome beliefs. Barriers included communication, information handover, credibility, relationships and skill gaps. Optometrists actively engaged in the programme in 2023 reported heightened satisfaction with their involvement, increased confidence and greater engagement in paediatric eyecare delivery. However, challenges in clinical information transfer persist. Conclusion: The interprofessional collaborative model of paediatric eyecare has contributed efficiencies within the health system by building paediatric care capacity in the community, fostering professional credibility and promoting interdisciplinary trust. Insights gained should prove valuable for other paediatric eyecare services exploring hospital‐to‐community care models.