This paper explores cultural and professional dynamics of HIV general practice nursing in Australia. It highlights specific contributions that HIV general practice nurses make to HIV medicine and considers how nurses’ clinical practice has been shaped by past experiences of the AIDS crisis and subsequent developments in HIV medicine.

In international contexts, nurses in HIV medicine commonly work as part of shared-care teams. In recent years, HIV general practice nursing has become a prioritised area for primary health care in Australia.

Data for this analysis were drawn from 45 in-depth, semi-structured interviews conducted with nurses and general practitioners (GPs) who provide HIV care in general practice, and key informants who work in policy, advocacy or education and training of the HIV general practice workforce.

Viewed through a socio-ecological framework of social capital, descriptive content analysis highlights a unique and strong HIV health professional identity, which emerged out of the adverse conditions experienced by nurses, GPs and allied health professionals during the 1980s AIDS crisis. Participants reported that today, HIV general practice nursing includes information provision, HIV treatment side-effect management, teaching patients methods to increase adherence to HIV treatments and capacity building with allied health professionals. Participants reported that HIV general practice nurses can reduce the clinical burden on GPs, ameliorate patients’ exposure to HIV health care-related stigma and discrimination and facilitate the emergence of a comprehensive and personalised model of shared primary health care based on trust and rapport, which is desired by people with HIV. This study's findings support the future expansion of the role of HIV general practice nurses in Australia and internationally. General practice nursing will become increasingly important in the scaling up of HIV testing and in caring for increasing numbers of people living with HIV.

‘Explanatory Models’ (EMs) are frameworks through which individuals and groups understand diseases, are influenced by cultural and religious perceptions of health and illness, and influence both physicians and patients’ behaviors.

To examine the role of EMs of illness (cancer-related perceptions) in physicians’ and laywomen’s behaviors (decision to recommend undergoing regular mammography, adhering to mammography) in the context of a traditional-religious society, that is, the Arab society in Israel.

Two combined samples were drawn: a representative sample of 146 Arab physicians who serve the Arab population and a sample composed of 290 Arab women, aged 50–70 years, representative of the main Arab groups residing in the north and center of Israel (Muslims, Christians) were each randomly sampled (cluster sampling). All respondents completed a closed-ended questionnaire.

Women held more cultural cancer-related beliefs and fatalistic beliefs than physicians. Physicians attributed more access barriers to screening as well as fear of radiation to women patients and lower social barriers to screening, compared with the women’s community sample. Higher fatalistic beliefs among women hindered the probability of adherence to mammography; physicians with higher fatalistic beliefs were less likely to recommend mammography.

The role of cultural perceptions needs to be particularly emphasized. In addition to understanding the patients’ perceptions of illness, physicians must also reflect on the social, cultural, and psychological factors that shape their decision to recommend undergoing regular mammography.

To identify: 1) best practice aged care principles and practices for Aboriginal and Torres Strait Islander older peoples, and 2) actions to integrate aged care services with Aboriginal community-controlled primary health care.

There is a growing number of older Aboriginal and Torres Strait Islander peoples and an unmet demand for accessible, culturally safe aged care services. The principles and features of aged care service delivery designed to meet the unique needs of Aboriginal and Torres Strait Islander peoples have not been extensively explored and must be understood to inform aged care policy and primary health care planning into the future.

The research was governed by leaders from across the Aboriginal community-controlled primary health care sector who identified exemplar services to explore best practice in culturally aligned aged care. In-depth case studies were undertaken with two metropolitan Aboriginal community-controlled services. We conducted semi-structured interviews and yarning circles with 46 staff members to explore key principles, ways of working, enablers and challenges for aged care service provision. A framework approach to thematic analysis was undertaken with emergent findings reviewed and refined by participating services and the governance panel to incorporate national perspectives.

A range of principles guided Aboriginal community-controlled aged care service delivery, such as supporting Aboriginal and Torres Strait Islander identity, connection with elders and communities and respect for self-determination. Strong governance, effective leadership and partnerships, Aboriginal and Torres Strait Islander workforce and culturally safe non-Indigenous workforce were among the identified enablers of aged care. Nine implementation actions guided the integration of aged care with primary health care service delivery. Funding limitations, workforce shortages, change management processes and difficulties with navigating the aged care system were among the reported challenges. These findings contribute to an evidence base regarding accessible, integrated, culturally safe aged care services tailored to the needs of Aboriginal and Torres Strait Islander peoples.

The coronavirus disease 2019 (COVID-19) pandemic and the resulting measures can impact daily life and healthcare management amongst patients with beta thalassemia major.

The Corbin and Strauss method of grounded theory was used to explore the impact of the COVID-19 pandemic on health-related quality of life (HRQoL) amongst Iranian patients with beta thalassemia major. Semi-structured interviews with 16 patients with thalassemia major in the eastern of Iran were performed. Data collection was conducted from 19 September through 18 November 2020. Collected data were recorded, transcribed, and coded to develop themes and subthemes. Paradigm components were sought to find out what happened to these patients and explore the process and events.

Insights from these interviews led to five major themes: ‘changing physical health’, ‘emotional and psychological reactions’, ‘changing the nature of relationships and the scope of social support’, ‘metamorphosis of ongoing healthcare, and ‘functionality and adaptation to new realities.’ The emerging core concept was labelled: ‘maintaining well-being balance.’ The COVID-19 pandemic disturbed the balance of life and health of the patients. Multiple strategies to maintain balance and reduce the negative effects of the COVID-19 pandemic on HRQoL were used by the patients, the healthcare team, and support systems.

Due to the fear of COVID-19, the patients with beta thalassemia were less likely to contact healthcare professionals. They considered postponing blood transfusion and abandoned evaluating disease complications. Reduced access to the healthcare system and shifting resources from existing programmes to COVID-19 by the healthcare system were incompatible policies. These policies and strategies had strong and negative effects on the physical domain of HRQoL. The patients experienced a deterioration of emotional functioning. They reported a strong reduction in social functioning and felt lonely. Online interventions supporting mental health and social interactions and telemedicine can help during the times of social distancing and lockdowns.

Changes to the general practice (GP) contract in England (April 2019) introduced a new quality improvement (QI) domain. The clinical microsystems programme is an approach to QI with limited evidence in primary care.

To explore experiences of GP staff participating in a clinical microsystems programme.

GPs within one clinical commissioning group (CCG) in South East England. Normalisation process theory informed qualitative approach.

Review of all CCG clinical microsystems projects using pre-existing data. The Diffusion of Innovation Cycle was used to inform the sampling frame and GPs were invited to participate in interviews or focus groups. Ten practices participated; 11 coaches and 16 staff were interviewed.

The majority of projects were process-driven activities related to administrative systems. Projects directly related to health outputs were fewer and related to externally imposed targets. Four key elements facilitated practices to engage: feeling in control; receiving enhanced service payment; having a senior staff member championing the approach; and good practice–coach relationship. There appeared to be three key benefits in addition to project-specific ones: improved working relationships between CCG and practice; more cohesive practice team; and time to reflect.

Small projects with clear parameters were more successful than larger ones or those spanning organisations. However, there was little evidence suggesting the key benefits were unique attributes of the microsystems approach and sustainability was problematic. Future research should focus on cross-organisational approaches to QI and identify what, if any, added value the approach provides.

This project evaluated the effectiveness of screening brief intervention and referral for treatment (SBIRT) in primary care in Abu Dhabi to manage patients with problematic substance use. This study aimed to determine whether: (i) training primary care physicians on the SBIRT model increased the identification of patients using substances at a harmful, hazardous or dependent level; (ii) training improved physicians’ knowledge, attitudes and beliefs in self-efficacy in managing substance use.

Substance use is increasing in the United Arab Emirates yet there has been no formal primary care intervention. SBIRT was considered an appropriate model given its endorsement by the WHO.

A controlled trial (two intervention and two matched control clinics) was undertaken. Intervention physicians (n=17) were trained in SBIRT. Physicians’ attitudes were measured before and after training and eight months after implementation. Target recruitment was 900 patients. Inclusion criteria were: consenting UAE national, ⩾18 years, using the ‘walk-in’ primary care clinic. Patient data was collected by physician-administered questionnaire. Prevalence of drug use was measured through electronic patient records.

A total of 906 patients were screened, aged 18–82 years and 496 (55%) were female. Of these, 5.7% reported use of amphetamine, 3.9% alcohol, 3.3%, sedatives, 1.7% opioids and 1.1% cannabis. In all, 21 people had a moderate/high ASSIST score and received a brief intervention, but did not attend follow-up; three high-risk people were referred for specialist treatment. Physicians’ attitudes towards patients with problematic substance use and providing treatment improved after training, but returned to pre-training levels after eight months. Including the 21 individuals identified from intervention screening, the prevalence of substance use increased to 0.208% (95% CI 0.154–0.274), significantly higher than in control clinics (P<0.001).

In conclusion, physicians were generally positive towards SBIRT and SBIRT increased recorded drug related conditions at a practice level. However, poor patient attendance at follow-up requires investigation.

To explore maternal perceptions of supervision and childhood unintentional injury in order to develop understanding and explanation for differences in unintentional injury rates between an advantaged and disadvantaged area.

Unintentional injury is the second cause of mortality and a significant cause of morbidity in the zero to four year age group. Children living in socio-economic disadvantage are at a greater risk of unintentional injury than their more affluent counter-parts.

Qualitative study using semi-structured interviews; content data analysis was undertaken. Participants included 37 mothers with a child aged less than five years; 16 living in an area of disadvantage (and high rate of childhood unintentional injury) and 21 living in an advantaged area (and low rate of childhood unintentional injury).

Parents in both areas described the importance of parental supervision in reducing child unintentional injury risks. Parents in both areas used listening as a supervision strategy. Parents in both areas described how ‘when the child goes quiet’ that is a cue for them to make a visual check on the child. Listening was used more for boys than girls in both areas, but parents in the advantaged area used listening as a supervision strategy more frequently than those in the disadvantaged area. Parents described supervision strategies as being shaped by child character and age rather than child gender. Parents in both areas described similar strategies for managing distractions. An important difference was found with regard to older siblings; parents living in the advantaged area described older siblings as an injury risk to younger children. Parents in the disadvantaged area described older siblings as providing some supervision for younger children. Parents living in disadvantaged circumstances may face greater challenges with regard to supervision than parents living in advantaged circumstances and this may partly explain differences in injury risk.

Work aggravated asthma (WAA), asthma made worse by but not caused by workplace exposures, can have a negative impact on personal, social, financial and societal costs. There is limited data on prevalence levels of WAA in Great Britain (GB). The objective of this study was to estimate the prevalence of WAA in GB, and to assess its potential causes.

A cross-sectional postal questionnaire study was carried out. A total of 1620 questionnaires were sent to three populations of adults with asthma. The questionnaire recorded; demographic details, current job, self-reported health status, presence of asthma and respiratory symptoms, duration and severity of symptoms and medication requirements. Questions relating to work environment and employers’ actions were included, and each participant completed an assessment of health-related quality of life using the EuroQol Research Foundation EQ-5D.

There were 207 completed questionnaires; response rates were 6% primary care, 45% secondary care and 71% Asthma UK. This represented a 13% overall response rate. Self-reported prevalence of WAA was 33% (95% CI 24.4–41.6%). In all, 19% of workers had changed their job because of breathing problems. Workers with WAA reported higher levels of work-related stress. Quality of life using the EQ-5D utility index was lower in those with WAA.

WAA is a common problem in asthmatics in GB. This result is in keeping with international prevalence rates. Further research could assist the understanding of the most significant aggravants to asthma at work and help define appropriate interventions by workplaces.

Care of children affected by AIDS in Swaziland is predominately provided by families, with support from ‘community-based responses’. This approach is consistent with United Nations International Children’s Fund’s (UNICEF) framework for the protection, care and support of children affected by AIDS. However, the framework relies heavily on voluntary caregiving which is highly gendered. It pays limited attention to caregivers’ well-being or sustainable community development which enables more effective caregiving. As a result, the framework is incompatible with the social justice principles of primary health care, and the sustainable development goals (SDGs).

Our aim was to examine the effects and gender dimensions of providing voluntary, community-based, care-related labour for children affected by AIDS.

We conducted multiple-methods research involving an ethnography and participatory health research, in a rural Swazi community. We analysed data related to community-based responses using an abductive, mixed-methods technique, informed by the capabilities approach to human development and a gender analysis framework.

Two community-based responses, ‘neighbourhood care points’ (facilities that provide children meals) and the ‘lihlombe lekukhalela’ (child protector) program were being implemented. The unpaid women workers at neighbourhood care points reported working in challenging conditions (eg, lacking labour-saving technologies), insufficient and diminishing material support (eg, no food), and receiving limited support from the broader community. Child protectors indicated their effectiveness was limited by lack of social power, relative to the perpetrators of child abuse. The results indicate that support for community-based responses will be enhanced by acknowledging and addressing the highly gendered nature of care-related labour and social power, and that increasing access to material resources including food, caregiver stipends and labour-saving technologies, is essential. These strategies will simultaneously contribute to the social and economic development of communities central to primary health care, and achieving the poverty, hunger, gender and work-related SDGs.

To introduce systems biology as a conceptual framework for research in family medicine, based on empirical data from a case study on the prediction of influenza vaccination outcomes. This concept is primarily oriented towards planning preventive interventions and includes systematic data recording, a multi-step research protocol and predictive modelling.

Factors known to affect responses to influenza vaccination include older age, past exposure to influenza viruses, and chronic diseases; however, constructing useful prediction models remains a challenge, because of the need to identify health parameters that are appropriate for general use in modelling patients’ responses.

The sample consisted of 93 patients aged 50–89 years (median 69), with multiple medical conditions, who were vaccinated against influenza. Literature searches identified potentially predictive health-related parameters, including age, gender, diagnoses of the main chronic ageing diseases, anthropometric measures, and haematological and biochemical tests. By applying data mining algorithms, patterns were identified in the data set. Candidate health parameters, selected in this way, were then combined with information on past influenza virus exposure to build the prediction model using logistic regression.

A highly significant prediction model was obtained, indicating that by using a systems biology approach it is possible to answer unresolved complex medical uncertainties. Adopting this systems biology approach can be expected to be useful in identifying the most appropriate target groups for other preventive programmes.

To identify learning from a clinical microsystems (CMS) quality improvement initiative to develop a more integrated service across a falls care pathway spanning community and hospital services.

Falls present a major challenge to healthcare providers internationally as populations age. A review of the falls care pathway in Sheffield, United Kingdom, identified that pathway implementation was constrained by inconsistent co-ordination and integration at the hospital–community interface.

The initiative utilised the CMS quality improvement approach and comprised three phases. Phase 1 focussed on developing a climate for change through engaging stakeholders across the existing pathway and coaching frontline teams operating as microsystems in quality improvement. Phase 2 involved initiating change by working at the mesosystem level to identify priorities for improvement and undertake tests of change. Phase 3 engaged decision makers at the macrosystem level from across the wider pathway in achieving change identified in earlier phases of the initiative.

The initiative was successful in delivering change in relation to key aspects of the pathway, engaging frontline staff and decision makers from different services within the pathway, and in building quality improvement capability within the workforce. Viewing the pathway as a series of interrelated CMS enabled stakeholders to understand the complex nature of the pathway and to target key areas for change. Particular challenges encountered arose from organisational reconfiguration and cross-boundary working.

CMS quality improvement methodology may be a useful approach to promoting integration across a care pathway. Using a CMS approach contributed towards clinical and professional integration of some aspects of the service. Recognition of the pathway operating at meso- and macrosystem levels fostered wider stakeholder engagement with the potential of improving integration of care across a range of health and care providers involved in the pathway.

To gain a clearer understanding of the attitudes of homeless women towards contraception in central London.

Homeless women are more vulnerable to sexually transmitted infections and unwanted pregnancies. This makes it imperative to address the health needs of this population. Evidence regarding the obstacles homeless women face when using contraception and accessing sexual/reproductive care is sparse, and almost non-existent in the United Kingdom (UK). American research has identified past experiences of women suffering side effects and their fear of serious health risks as deterrents of sustained contraceptive use among this population.

This study used convenience sampling and semi-structured face-to-face interviews. During the interview, a topic guide was used to ensure data relevant to the study aim were being collected. In total, 14 English-speaking women, previously street homeless and/or living in temporary accommodation from two homeless shelters located in central London, were interviewed.

In summary, the results suggest this group of study respondents find ongoing access to advice on contraception services difficult largely because of their homelessness. This pre-eminent factor alongside their vulnerability inevitably means that other issues take precedence on a daily basis. Furthermore, issues such as individual choice of contraception and the perceptions of this group of women to health professionals ultimately determine whether women receive the services they need. Bearing in mind the paucity of studies in this area of homelessness, the results point to the need for more research and to the allied question ‘how is it best to provide contraceptive services to those women who find themselves homeless?’

This paper explores the variable provision of English health visiting services, despite government emphasis on the need to reduce health inequalities through early interventions and provide support to families with pre-school children.

There is increasing evidence of the importance to later health of early child development; that is from prenatal to eight years of age. In this population group, the strongest evidence for health improvement emphasizes support for families (especially mothers) until the infant is at least two to three years of age. In the last four to five years, English government policy has focused strongly on this important life stage, particularly noting its relevance in reducing health inequalities. Simultaneously, the health visiting workforce, arguably the occupational group most closely associated with this form of work, has reduced by 10%; and there is evidence of extreme variability in the way services are provided across the country.

Three sources of data were analysed to discover whether the variation in health visiting services relates to need, levels of deprivation or whether other factors are influential in planning provision. The ratio of health visitors to pre-school children was mapped to indices of multiple deprivations across 144 Primary Care Trusts. Survey data were examined for evidence of links, or not, to levels of deprivation and, finally, 30 Children and Young People’s Plans (CYPPs) were analysed to explore strategic planning about the distribution and type of services.

Health visiting service provision appears unrelated to areas of deprivation; although, the survey data offered some evidence that individual practitioners focused efforts on the most deprived clients on their caseloads, regardless of location. At a strategic level, the CYPPs made little mention of pre-school children or their needs and offered only limited descriptions of preventive health services. Policy recommendations are made about strengthening service provision in this field.

Older people from deprived areas, the oldest old and those from ethnic minorities engage less in health promotion interventions and related research, potentially generating inequities.

To explore and map the extent to which such ‘hard to reach’ groups of older people, are the focus of local health and well-being strategies in England.

Document analysis of current health and well-being promotion strategies in a purposive sample of 10 localities in England with high proportions of some or all of the three hard to reach groups. Documents were analysed using an interpretive approach.

A total of 254 documents were retrieved and reviewed. Much of the content of the documents was descriptive and reported the implications for resources/services of population ageing rather than actual initiatives. All localities had an Older People’s Strategy. Strategies to counter deprivation included redistribution of winter fuel payments, income maximisation, debt reduction and social inclusion initiatives, a focus on older owner occupiers and recruitment of village ‘agents’ to counter rural deprivation. The needs of the oldest old were served by integrated services for older people, a community alarm service with total coverage of the 85+ population, and dietary advice. The needs of black and minority ethnic (BME) older people were discussed in all localities and responses included community work with BME groups, attention to housing needs and monitoring of service use by BME older people. Three other themes that emerged were: use of telecare technologies; a challenge to the idea of ‘hard to reach’ groups; and outreach services to those at most risk.

Document analysis revealed a range of policy statements that may indicate tailoring of policy and practice to local conditions, the salience of national priorities, some innovative local responses to policy challenges and even dissenting views that seek to redefine the policy problem.

The study objective was to evaluate an eight-week Mindfulness-Based Stress Reduction (MBSR) treatment group for chronic pain in terms of effects on pain disability, subjective ratings of pain and psychological distress related to pain, and activity level and willingness to experience pain. This pilot study evaluated the impact of two eight-week MBSR treatment groups that were delivered in a clinic in Winnipeg, Manitoba.

Chronic pain is one of the most common presenting problems in primary care settings.

Adult patients with chronic pain were recruited from 20 clinics that are part of a collaborative care programme and outcome measures were administered at baseline and programme completion.

Despite a modest attendance rate and the short length of programme, a pre–post evaluation involving 17 patients revealed significant and/or clinically relevant improvements in level of pain disability, psychological distress, engagement in life activities, willingness to experience pain, and subjective rating of current pain.

To investigate general practitioners’ (GPs’) desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.

Excluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8–15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test’s potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.

An online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.

A total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.

Primary care is an important area in which to confront situations of food and nutrition insecurity. To undertake action in this area, well-prepared professionals are necessary. Courses of health training are not yet, however, equipped to offer the necessary preparation.

To analyse the topics taught in nutrition graduation courses related to the abilities and competencies demanded by professional work in this area.

The curricula of the nutrition courses offered in the municipality of São Paulo, Brazil were analysed. Nutritionists and teachers were interviewed. The triangulation of the data obtained was undertaken by means of a qualitative approach taking the theory of social representations as the frame of reference.

The concepts necessary to act within the context of food and nutrition security are related to a humanistic approach, the unity of theory and practice, the nutritionist’s role as educator, teamwork and reflection on public health.