Justin McNab - Academia.edu (original) (raw)

Papers by Justin McNab

Nutrients, Dec 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

BMC Pregnancy and Childbirth, Jun 9, 2023

Background As a COVID-19 risk mitigation measure, Australia closed its international borders for ... more Background As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk. Aim To explore women's experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness. Methods A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis. Results There were 24 participants interviewed both antenatally and postnatally (22 antenatal; 18 postnatal). Fourteen women were migrants and 10 Australian born. Main themes included; 'Significant disruption and loss of peripartum support during the COVID-19 pandemic and ongoing impact for migrant women'; 'Husbands/partners filling the support gap' and 'Holding on by a virtual thread'. Half of the participants felt unsupported antenatally. For Australian born women, this dissipated postnatally, but migrants continued to feel unsupported. Migrant women discussed partners stepped into traditional roles and duties of absent mothers and mothers-in-law who were only available virtually. Conclusion This study identified disrupted social support for migrant women during the pandemic, providing further evidence that the pandemic has disproportionately impacted migrant populations. However, the benefits identified in this study included high use of virtual support, which could be leveraged for improving clinical care in the present and in future pandemics. The COVID-19 pandemic impacted most women's peripartum social support

Australian Journal of Primary Health, 2017

Coordination of health services is thought to improve health outcomes for patients with chronic a... more Coordination of health services is thought to improve health outcomes for patients with chronic and complex illness; however, there is limited quantitative evidence for the effectiveness of coordinated care programs. HealthOne Mount Druitt (HOMD) is a coordinated care program operating in a disadvantaged area of Western Sydney, Australia. It operates as a combination 'virtual' and 'hub and spoke' model, with care coordination provided by liaison nurses. We aimed to determine whether there were changes in the number of emergency department (ED) presentations, length of stay, and community health referrals in the 12 months following enrolment in HOMD, compared to the 12 months prior. A quantitative survey was also conducted to determine the perspectives of service providers on key aspects of HOMD. Enrolment in HOMD was followed by reductions in both the number of ED presentations and the amount of time spent by patients in the ED. Community health referrals were increased, and the pattern of referral to different types of community health services was altered. This study provides quantitative evidence that a coordinated care intervention improves patient health outcomes.

Gerontologist, Dec 17, 2019

Background and Objectives: Older adults' self-perceptions of aging and being older can influence ... more Background and Objectives: Older adults' self-perceptions of aging and being older can influence well-being and quality of life. This systematic scoping review aimed to map out current research on older adults' self-perceptions of aging and being older. Research Design and Methods: The scoping review followed Arksey and O'Malley's methodological framework. A total of 5,037 records were identified (duplicates removed). After screening, a final 148 papers were included. Descriptives, including year of publication, methodology, age, gender, and location of participants, were calculated. Thematic analyses were conducted examining ways in which the topic was conceptualized. Results: The most frequent method used in the research was quantitative. Participants were from 38 different countries. There were more female participants than male. Seven themes representing the main research emphasis emerged: attitudes towards one's own aging (n = 48), aging well (n = 23), aging stereotypes, self-stigma (n = 23), construction of aging identities (n = 22), subjective age (n = 18), the aging body (n = 8), and future self-views (n = 6). Discussion and Implications: The research within these themes approach self-perceptions of aging using varying points of reference for what participants compare their age to. The methods used to illicit aging perspectives held their own assumptions about aging.

Is transport a barrier to healthcare for older people with chronic diseases

Asia Pacific journal of health management, Jun 1, 2012

Objective: This review aimed to determine whether lack of transport is a barrier to accessing rou... more Objective: This review aimed to determine whether lack of transport is a barrier to accessing routine health services for older people with chronic diseases and, if so, to identify the nature and effectiveness of interventions trialed to overcome this barrier. Methods: We conducted a systematic literature review using MEDLINE, Embase, Cinahl, PsycINFO and the Cochrane Library databases for articles published in English from 1990 to 2010 using relevant MESH terms. Results: Seven hundred and ninety eight citations were identified from electronic data bases searched and two from references of potential articles. Thirteen studies met the inclusion criteria. Twelve were cross-sectional and one interventional. Of the 13, seven studies reported that lack of transport was a barrier to accessing cardiac rehabilitation (CR) services. Three studies identified transport as a barrier to accessing general services in older adults. Access to transport significantly predicted receipt of definitive cancer therapy. People who missed or cancelled an appointment for asthma care perceived lack of transport as a greater barrier than those who did not. One study which evaluated a transport brokerage service identified a decrease in non-emergency transport costs despite an increase in monthly health services use. Conclusion: Lack of transport has the potential to negatively influence the ability of older adults to access a variety of health services. In our review this effect was most apparent in CR programs which were the focus of the majority of the studies identified through our searches. There was insufficient evidence to assess the effectiveness of interventions. Implications: Further research is needed in the Australian context. Interventions need to be trialed to inform the policy response. Health service planners and providers should evaluate the accessibility of their services for older people with chronic diseases and take measures to ameliorate lack of transport as a barrier to appropriate use of health services.

Exploring the COVID-19 pandemic experience of maternity clinicians in a high migrant population and low COVID-19 prevalence country: A qualitative study

Women and Birth, Sep 1, 2022

Background Australia experienced a low prevalence of COVID-19 in 2020 compared to many other coun... more Background Australia experienced a low prevalence of COVID-19 in 2020 compared to many other countries. However, maternity care has been impacted with hospital policy driven changes in practice. Little qualitative research has investigated maternity clinicians’ perception of the impact of COVID-19 in a high-migrant population. Aim To investigate maternity clinicians’ perceptions of patient experience, service delivery and personal experience in a high-migrant population. Methods We conducted semi-structured in-depth interviews with 14 maternity care clinicians in Sydney, New South Wales, Australia. Interviews were conducted from November to December 2020. A reflexive thematic approach was used for data analysis. Findings A key theme in the data was ‘COVID-19 related travel restrictions result in loss of valued family support for migrant families’. However, partners were often ‘stepping-up’ into the role of missing overseas relatives. The main theme in clinical care was a shift in healthcare delivery away from optimising patient care to a focus on preservation and safety of health staff. Discussion Clinicians were of the view migrant women were deeply affected by the loss of traditional support. However, the benefit may be the potential for greater gender equity and bonding opportunities for partners. Conflict with professional beneficence principles and values may result in bending rules when a disconnect exists between relaxed community health orders and restrictive hospital protocols during different phases of a pandemic. Conclusion This research adds to the literature that migrant women require individualised culturally safe care because of the ongoing impact of loss of support during the COVID-19 pandemic.

International Journal of Integrated Care, Sep 23, 2015

HealthOne was part of a statewide initiative to invest in new community-based facilities for coll... more HealthOne was part of a statewide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on 'virtual' care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs) work closely with clients as well as general practitioners (GPs) and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED) for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.

BMJ Open, Jul 1, 2022

Objective Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian ... more Objective Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian high migrant and low COVID-19 prevalent population to identify if COVID-19 driven health service changes and societal influences impact obstetric and perinatal outcomes.

Australian Journal of Primary Health, 2016

This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integr... more This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integration and coordination of services within Primary Health Care. This position can play a major role in care coordination and cultural change. The GPLN within HealthOne Mt Druitt (HOMD) identifies patients' needs and facilitates communication, case conferencing and care coordination between health and other providers. The priority areas of children and their families at risk or with significant unmet needs, and chronic aged and complex care, were identified as target areas. This paper focuses on the GPLN within the chronic aged and complex care service model. The GPLN within HOMD was able to improve coordination and integration of services for patients of the facility. Activities included organising multidisciplinary services and addressing psychosocial issues. Patients and community health staff identified the importance of the role for improving coordination and integration of services. Decision and policy makers saw the position as vital to the implementation, operation and sustainability of HOMD.

Co-designing alternative frames of ageing and experiences of challenging ageism in Australia

Educational Gerontology, May 4, 2022

Research Square (Research Square), May 29, 2023

Background: Women living with metastatic breast cancer can bene t from physical activity. To enab... more Background: Women living with metastatic breast cancer can bene t from physical activity. To enable effective physical activity advice and services, it is important to understand the practical factors that may facilitate or prevent engagement. For women living with metastatic breast cancer, we explored: i) practical and behavioural factors that in uenced physical activity, and ii) the role of healthcare services in in uencing engagement in being physically active. Methods: Recruitment took place at a metropolitan cancer centre. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering healthspeci c factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity levels ranged from regular participation in structured exercise to simple incidental activity. Seven themes organised into three categories were identi ed. The category 'personal context' incorporated themes on: 1) both cancer and non-cancer related health factors; 2) time, work and family factors; and 3) exercise history and preferences. The category 'strategies for physical activity' incorporated themes on: 4) self-e cacy, and 5) routine and incidental activity. The category 'role of health and physical activity services' incorporated themes on: 6) tailored education and services, and 7) speci c metastatic cancer services and considerations. Conclusions: Participants expressed diverse experiences with physical activity, with common notions on how physical activity is bene cial but di cult in which to adhere. Whilst some barriers to engagement in physical activity were unique to having cancer, many were not speci c to metastatic breast cancer. A patient-centred approach tailored to this group's health and behavioural context may be effective for women who are currently inactive to engage in physical activity.

Research Square (Research Square), May 29, 2023

Background: The bene cial role of physical activity for people living with cancer is well establi... more Background: The bene cial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity in uence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group. Methods: Women living with metastatic breast cancer were recruited through a metropolitan cancer centre to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-speci c factors, goals, barriers, enablers, and interests.Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but found it challenging, and four reported nominal interest in physical activity. Four categories, covering nine themes, were identi ed: i) predispositions towards physical activity, incorporating themes on enjoyment and energy, and positivity and mental resilience; ii) health-related reasons behind physical activity, incorporating themes on motivation from physical and mental health bene ts; iii) social in uences behind physical activity, incorporating themes on enjoying exercise with others, role models and social support, and others' perceptions of metastatic breast cancer; and iv) connections between physical activity and metastatic breast cancer, incorporating themes on the uncertainty of health, and reframing limiting perceptions. Conclusions: Participants described a wide-ranging spectrum of experiences and perceptions toward physical activity. Whilst most women perceived improved physical and mental well-being from being physically active, some women were not engaged in being physically active. Behaviour change strategies that target both their attitudes and those around them may address this gap.

Australian and New Zealand journal of public health, Dec 1, 2011

Gerontologist, Jan 28, 2020

Australian & New Zealand Journal of Obstetrics & Gynaecology, Oct 19, 2022

BackgroundOn 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Austr... more BackgroundOn 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy.AimThis multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy.Materials and methodsAn online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021.ResultsThere were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01).ConclusionsAlong with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women.

Report of the Evaluation of HealthOne Mount Druitt

BMC Pregnancy and Childbirth

Background As a COVID-19 risk mitigation measure, Australia closed its international borders for ... more Background As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk. Aim To explore women’s experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness. Methods A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis. Results There were 24 participants interviewed both antenatally and postnatally (22 antenatal...

Practical factors that influence physical activity in women living with metastatic breast cancer: a qualitative interview study

Background: Women living with metastatic breast cancer can benefit from physical activity. To ena... more Background: Women living with metastatic breast cancer can benefit from physical activity. To enable effective physical activity advice and services, it is important to understand the practical factors that may facilitate or prevent engagement. For women living with metastatic breast cancer, we explored: i) practical and behavioural factors that influenced physical activity, and ii) the role of healthcare services in influencing engagement in being physically active. Methods: Recruitment took place at a metropolitan cancer centre. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity levels ranged fr...

Motivations and perceptions for physical activity in women living with metastatic breast cancer: a qualitative interview study

Background: The beneficial role of physical activity for people living with cancer is well establ... more Background: The beneficial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity influence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group. Methods: Women living with metastatic breast cancer were recruited through a metropolitan cancer centre to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-specific factors, goals, barriers, enablers, and interests.Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but foun...

BMC Public Health

Background Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aborigin... more Background Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management. Aim To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management. Methods AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework ‘8 Ways of learning’, which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise ...

Nutrients, Dec 20, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

BMC Pregnancy and Childbirth, Jun 9, 2023

Background As a COVID-19 risk mitigation measure, Australia closed its international borders for ... more Background As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk. Aim To explore women's experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness. Methods A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis. Results There were 24 participants interviewed both antenatally and postnatally (22 antenatal; 18 postnatal). Fourteen women were migrants and 10 Australian born. Main themes included; 'Significant disruption and loss of peripartum support during the COVID-19 pandemic and ongoing impact for migrant women'; 'Husbands/partners filling the support gap' and 'Holding on by a virtual thread'. Half of the participants felt unsupported antenatally. For Australian born women, this dissipated postnatally, but migrants continued to feel unsupported. Migrant women discussed partners stepped into traditional roles and duties of absent mothers and mothers-in-law who were only available virtually. Conclusion This study identified disrupted social support for migrant women during the pandemic, providing further evidence that the pandemic has disproportionately impacted migrant populations. However, the benefits identified in this study included high use of virtual support, which could be leveraged for improving clinical care in the present and in future pandemics. The COVID-19 pandemic impacted most women's peripartum social support

Australian Journal of Primary Health, 2017

Coordination of health services is thought to improve health outcomes for patients with chronic a... more Coordination of health services is thought to improve health outcomes for patients with chronic and complex illness; however, there is limited quantitative evidence for the effectiveness of coordinated care programs. HealthOne Mount Druitt (HOMD) is a coordinated care program operating in a disadvantaged area of Western Sydney, Australia. It operates as a combination 'virtual' and 'hub and spoke' model, with care coordination provided by liaison nurses. We aimed to determine whether there were changes in the number of emergency department (ED) presentations, length of stay, and community health referrals in the 12 months following enrolment in HOMD, compared to the 12 months prior. A quantitative survey was also conducted to determine the perspectives of service providers on key aspects of HOMD. Enrolment in HOMD was followed by reductions in both the number of ED presentations and the amount of time spent by patients in the ED. Community health referrals were increased, and the pattern of referral to different types of community health services was altered. This study provides quantitative evidence that a coordinated care intervention improves patient health outcomes.

Gerontologist, Dec 17, 2019

Background and Objectives: Older adults' self-perceptions of aging and being older can influence ... more Background and Objectives: Older adults' self-perceptions of aging and being older can influence well-being and quality of life. This systematic scoping review aimed to map out current research on older adults' self-perceptions of aging and being older. Research Design and Methods: The scoping review followed Arksey and O'Malley's methodological framework. A total of 5,037 records were identified (duplicates removed). After screening, a final 148 papers were included. Descriptives, including year of publication, methodology, age, gender, and location of participants, were calculated. Thematic analyses were conducted examining ways in which the topic was conceptualized. Results: The most frequent method used in the research was quantitative. Participants were from 38 different countries. There were more female participants than male. Seven themes representing the main research emphasis emerged: attitudes towards one's own aging (n = 48), aging well (n = 23), aging stereotypes, self-stigma (n = 23), construction of aging identities (n = 22), subjective age (n = 18), the aging body (n = 8), and future self-views (n = 6). Discussion and Implications: The research within these themes approach self-perceptions of aging using varying points of reference for what participants compare their age to. The methods used to illicit aging perspectives held their own assumptions about aging.

Is transport a barrier to healthcare for older people with chronic diseases

Asia Pacific journal of health management, Jun 1, 2012

Objective: This review aimed to determine whether lack of transport is a barrier to accessing rou... more Objective: This review aimed to determine whether lack of transport is a barrier to accessing routine health services for older people with chronic diseases and, if so, to identify the nature and effectiveness of interventions trialed to overcome this barrier. Methods: We conducted a systematic literature review using MEDLINE, Embase, Cinahl, PsycINFO and the Cochrane Library databases for articles published in English from 1990 to 2010 using relevant MESH terms. Results: Seven hundred and ninety eight citations were identified from electronic data bases searched and two from references of potential articles. Thirteen studies met the inclusion criteria. Twelve were cross-sectional and one interventional. Of the 13, seven studies reported that lack of transport was a barrier to accessing cardiac rehabilitation (CR) services. Three studies identified transport as a barrier to accessing general services in older adults. Access to transport significantly predicted receipt of definitive cancer therapy. People who missed or cancelled an appointment for asthma care perceived lack of transport as a greater barrier than those who did not. One study which evaluated a transport brokerage service identified a decrease in non-emergency transport costs despite an increase in monthly health services use. Conclusion: Lack of transport has the potential to negatively influence the ability of older adults to access a variety of health services. In our review this effect was most apparent in CR programs which were the focus of the majority of the studies identified through our searches. There was insufficient evidence to assess the effectiveness of interventions. Implications: Further research is needed in the Australian context. Interventions need to be trialed to inform the policy response. Health service planners and providers should evaluate the accessibility of their services for older people with chronic diseases and take measures to ameliorate lack of transport as a barrier to appropriate use of health services.

Exploring the COVID-19 pandemic experience of maternity clinicians in a high migrant population and low COVID-19 prevalence country: A qualitative study

Women and Birth, Sep 1, 2022

Background Australia experienced a low prevalence of COVID-19 in 2020 compared to many other coun... more Background Australia experienced a low prevalence of COVID-19 in 2020 compared to many other countries. However, maternity care has been impacted with hospital policy driven changes in practice. Little qualitative research has investigated maternity clinicians’ perception of the impact of COVID-19 in a high-migrant population. Aim To investigate maternity clinicians’ perceptions of patient experience, service delivery and personal experience in a high-migrant population. Methods We conducted semi-structured in-depth interviews with 14 maternity care clinicians in Sydney, New South Wales, Australia. Interviews were conducted from November to December 2020. A reflexive thematic approach was used for data analysis. Findings A key theme in the data was ‘COVID-19 related travel restrictions result in loss of valued family support for migrant families’. However, partners were often ‘stepping-up’ into the role of missing overseas relatives. The main theme in clinical care was a shift in healthcare delivery away from optimising patient care to a focus on preservation and safety of health staff. Discussion Clinicians were of the view migrant women were deeply affected by the loss of traditional support. However, the benefit may be the potential for greater gender equity and bonding opportunities for partners. Conflict with professional beneficence principles and values may result in bending rules when a disconnect exists between relaxed community health orders and restrictive hospital protocols during different phases of a pandemic. Conclusion This research adds to the literature that migrant women require individualised culturally safe care because of the ongoing impact of loss of support during the COVID-19 pandemic.

International Journal of Integrated Care, Sep 23, 2015

HealthOne was part of a statewide initiative to invest in new community-based facilities for coll... more HealthOne was part of a statewide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on 'virtual' care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs) work closely with clients as well as general practitioners (GPs) and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED) for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.

BMJ Open, Jul 1, 2022

Objective Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian ... more Objective Investigate the impact of the COVID-19 pandemic on perinatal outcomes in an Australian high migrant and low COVID-19 prevalent population to identify if COVID-19 driven health service changes and societal influences impact obstetric and perinatal outcomes.

Australian Journal of Primary Health, 2016

This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integr... more This paper explores the role of the General Practitioner Liaison Nurse (GPLN) in improving integration and coordination of services within Primary Health Care. This position can play a major role in care coordination and cultural change. The GPLN within HealthOne Mt Druitt (HOMD) identifies patients' needs and facilitates communication, case conferencing and care coordination between health and other providers. The priority areas of children and their families at risk or with significant unmet needs, and chronic aged and complex care, were identified as target areas. This paper focuses on the GPLN within the chronic aged and complex care service model. The GPLN within HOMD was able to improve coordination and integration of services for patients of the facility. Activities included organising multidisciplinary services and addressing psychosocial issues. Patients and community health staff identified the importance of the role for improving coordination and integration of services. Decision and policy makers saw the position as vital to the implementation, operation and sustainability of HOMD.

Co-designing alternative frames of ageing and experiences of challenging ageism in Australia

Educational Gerontology, May 4, 2022

Research Square (Research Square), May 29, 2023

Background: Women living with metastatic breast cancer can bene t from physical activity. To enab... more Background: Women living with metastatic breast cancer can bene t from physical activity. To enable effective physical activity advice and services, it is important to understand the practical factors that may facilitate or prevent engagement. For women living with metastatic breast cancer, we explored: i) practical and behavioural factors that in uenced physical activity, and ii) the role of healthcare services in in uencing engagement in being physically active. Methods: Recruitment took place at a metropolitan cancer centre. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering healthspeci c factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity levels ranged from regular participation in structured exercise to simple incidental activity. Seven themes organised into three categories were identi ed. The category 'personal context' incorporated themes on: 1) both cancer and non-cancer related health factors; 2) time, work and family factors; and 3) exercise history and preferences. The category 'strategies for physical activity' incorporated themes on: 4) self-e cacy, and 5) routine and incidental activity. The category 'role of health and physical activity services' incorporated themes on: 6) tailored education and services, and 7) speci c metastatic cancer services and considerations. Conclusions: Participants expressed diverse experiences with physical activity, with common notions on how physical activity is bene cial but di cult in which to adhere. Whilst some barriers to engagement in physical activity were unique to having cancer, many were not speci c to metastatic breast cancer. A patient-centred approach tailored to this group's health and behavioural context may be effective for women who are currently inactive to engage in physical activity.

Research Square (Research Square), May 29, 2023

Background: The bene cial role of physical activity for people living with cancer is well establi... more Background: The bene cial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity in uence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group. Methods: Women living with metastatic breast cancer were recruited through a metropolitan cancer centre to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-speci c factors, goals, barriers, enablers, and interests.Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but found it challenging, and four reported nominal interest in physical activity. Four categories, covering nine themes, were identi ed: i) predispositions towards physical activity, incorporating themes on enjoyment and energy, and positivity and mental resilience; ii) health-related reasons behind physical activity, incorporating themes on motivation from physical and mental health bene ts; iii) social in uences behind physical activity, incorporating themes on enjoying exercise with others, role models and social support, and others' perceptions of metastatic breast cancer; and iv) connections between physical activity and metastatic breast cancer, incorporating themes on the uncertainty of health, and reframing limiting perceptions. Conclusions: Participants described a wide-ranging spectrum of experiences and perceptions toward physical activity. Whilst most women perceived improved physical and mental well-being from being physically active, some women were not engaged in being physically active. Behaviour change strategies that target both their attitudes and those around them may address this gap.

Australian and New Zealand journal of public health, Dec 1, 2011

Gerontologist, Jan 28, 2020

Australian & New Zealand Journal of Obstetrics & Gynaecology, Oct 19, 2022

BackgroundOn 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Austr... more BackgroundOn 9 June 2021, the Australian Technical Advisory Group on Immunisation and Royal Australian and New Zealand College of Obstetricians and Gynaecologists recommended that pregnant women receive Comirnaty (Pfizer) messenger RNA vaccine at any stage of pregnancy.AimThis multi‐centre study aimed to assess vaccine acceptance, reasons for hesitancy and determine if differences exist between health districts, to inform future policy strategies for COVID‐19 vaccination in pregnancy.Materials and methodsAn online survey (developed based on the World Health Organization Behavioural and Social Drivers survey and modified for the pregnant population) was administered to a sample population of pregnant women attending antenatal clinics at two metropolitan hospitals (Westmead and Royal North Shore Hospital (RNSH)) in New South Wales between 15 September 2021 and 22 October 2021.ResultsThere were 287 pregnant women surveyed (Westmead 198 (69%), RNSH 66 (23%), no site 23 (8%)). There was a significantly lower Socio‐Economic Indexes for Areas score (5.66 vs 9.45, P = 0.001), fewer women born in Australia (37% vs 53%, P = 0.02) and higher number of children (0.77 vs 0.41, P = 0.01) among Westmead respondents. There was lower vaccination uptake (68% vs 86%, P = 0.01) and willingness to receive vaccine (68% vs 88% P = 0.01) at Westmead compared to RNSH. There was an increased proportion of respondents who were concerned that the vaccine could cause harm to the unborn baby at Westmead (38% vs 11%, P = 0.01).ConclusionsAlong with healthcare provider recommendation for vaccination in pregnancy, materials should be targeted to specific safety concerns of pregnant women.

Report of the Evaluation of HealthOne Mount Druitt

BMC Pregnancy and Childbirth

Background As a COVID-19 risk mitigation measure, Australia closed its international borders for ... more Background As a COVID-19 risk mitigation measure, Australia closed its international borders for two years with significant socioeconomic disruption including impacting approximately 30% of the Australian population who are migrants. Migrant populations during the peripartum often rely on overseas relatives visiting for social support. High quality social support is known to lead to improved health outcomes with disruption to support a recognised health risk. Aim To explore women’s experience of peripartum social support during the COVID-19 pandemic in a high migrant population. To quantify type and frequency of support to identify characteristics of vulnerable perinatal populations for future pandemic preparedness. Methods A mixed methods study with semi-structured interviews and a quantitative survey was conducted from October 2020 to April 2021. A thematic approach was used for analysis. Results There were 24 participants interviewed both antenatally and postnatally (22 antenatal...

Practical factors that influence physical activity in women living with metastatic breast cancer: a qualitative interview study

Background: Women living with metastatic breast cancer can benefit from physical activity. To ena... more Background: Women living with metastatic breast cancer can benefit from physical activity. To enable effective physical activity advice and services, it is important to understand the practical factors that may facilitate or prevent engagement. For women living with metastatic breast cancer, we explored: i) practical and behavioural factors that influenced physical activity, and ii) the role of healthcare services in influencing engagement in being physically active. Methods: Recruitment took place at a metropolitan cancer centre. Women living with metastatic breast cancer were asked to participate in semi-structured interviews about physical activity, covering health-specific factors, goals, barriers, enablers, and interests. Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women completed the interview, with a median age of 60 years (IQR: 20) and median time since metastatic diagnosis of 3.3 years (IQR: 3.0). Physical activity levels ranged fr...

Motivations and perceptions for physical activity in women living with metastatic breast cancer: a qualitative interview study

Background: The beneficial role of physical activity for people living with cancer is well establ... more Background: The beneficial role of physical activity for people living with cancer is well established. However, the importance of physical activity to women living with metastatic breast cancer is not known. As motivations and perceptions around physical activity influence behavioural uptake, a qualitative study was undertaken to explore the motivations and perceptions towards physical activity of this group. Methods: Women living with metastatic breast cancer were recruited through a metropolitan cancer centre to participate in semi-structured interviews about their physical activity. Open-ended questions explored health-specific factors, goals, barriers, enablers, and interests.Interviews were recorded, transcribed and thematically analysed. Results: Twenty-three women participated; median age was 60 years (IQR: 20) and median time since metastatic diagnosis was 3.3 years (IQR: 3.0). Twelve women were engaged with physical activity, seven reported intentions to be active but foun...

BMC Public Health

Background Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aborigin... more Background Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management. Aim To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management. Methods AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework ‘8 Ways of learning’, which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise ...