List of Titles

Perspectives on the training of Chinese Primary Health Care Physicians to reduce chronic illnesses and their burden

- Sun, Wenmin, Li, Yang, Hu, Yitting, Rao, Xin, Xu, Xingzhi, Browning, Colette, Thomas, Shane

Authors: Sun, Wenmin , Li, Yang , Hu, Yitting , Rao, Xin , Xu, Xingzhi , Browning, Colette , Thomas, Shane
Date: 2019
Type: Text , Journal article
Relation: Frontiers in Public Health Vol. 7, no. (2019), p. 1-7
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Description: This paper is a commentary on the training of Chinese Primary Health Care Doctors to reduce chronic illness and its burden. First, we will consider the policy position of the Chinese government concerning the development of a competent and enlarged primary physician workforce to deliver the proposed primary health care system reforms. We then turn to a review of the drivers of the high burden of chronic illnesses especially in older people in China. We argue that the curriculum for the training of primary health care medical practitioners should match the demonstrated high prevalence chronic illnesses and their risk factors and that there needs to specific competencies in prevention and mitigation of the diseases and their risk factors.

Self-assessed impact of oral health on the psychological well-being and depressive symptoms of older adults living in Melbourne

- Mariño, Rodrigo, Enticott, Joanne, Browning, Colette, Elsamman, Mahmoud, Etzion, Rachel, Ferooz, Maryam, Fujihara, Ryuun, Hancock, Hugo, He, Julian, Kendig, Hal

Authors: Mariño, Rodrigo , Enticott, Joanne , Browning, Colette , Elsamman, Mahmoud , Etzion, Rachel , Ferooz, Maryam , Fujihara, Ryuun , Hancock, Hugo , He, Julian , Kendig, Hal
Date: 2020
Type: Text , Journal article
Relation: Journal of Public Health Dentistry Vol. 80, no. 3 (2020), p. 177-185
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Description: Objectives: This study aimed to investigate oral health-related factors affecting the self-assessed psychological well-being (PW) and depressive symptoms of independent-living Australians aged 79 years and over living in the community in metropolitan Melbourne. Methods: The Melbourne Longitudinal Studies on Healthy Aging (MELSHA) program was used as the data source in this study and includes data on the health and well-being of older participants. The MELSHA baseline data collection occurred in 1994, the current study used data from the 2008 data collection and included 201 participants, who remained in the study. Data were analyzed using multiple linear regression (MLR) analysis with a stepwise procedure to identify the variables that accounted for a significant proportion of the variance in the participants' PW scores. Results: Present findings indicate that oral health may play a significant mediating role in PW through maintaining a presentable and acceptable physical appearance. Some 16.4 percent of participants reported feeling concerned about their dental appearance, either “Sometimes,” “Often,” or “Very often.” Multivariate analysis showed significantly influences on PW positive and negative affect scores (P ' 0.0001); and depressive symptoms (P ' 0.0001) by participants' dentition status, enjoyment of meals, self-reported feeling of concern about the appearance of the mouth, social activity and self-assessment of general health. Final models explained 17.8, 20.1, and 24.6 percent of the variance of PW positive, negative affect scores, and depressive symptoms, respectively. Conclusions: Oral health, specifically the appearance of the mouth and dentition, plays a significant role in the PW of older Melbournians. Future cross-sectional and longitudinal studies are indicated to raise awareness on the changes required to improve the quality of life of the older population. © 2020 American Association of Public Health Dentistry
Description: Funding details: National Health and Medical Research Council, NHMRC, 148625, 219295

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Non-communicable diseases and cognitive impairment : pathways and shared behavioral risk factors among older Chinese

- Yiengprugsawan, Vasoontara, Browning, Colette

Authors: Yiengprugsawan, Vasoontara , Browning, Colette
Date: 2019
Type: Text , Journal article , Review
Relation: Frontiers in Public Health Vol. 7, no. (Oct 2019), p. 7
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Description: Population aging has brought about a number of challenges to public health and primary health care systems due to increases in the prevalence of non-communicable diseases (NCDs). As a country with one of the largest populations globally, China is confronting a rising number of chronic NCDs including cardiometabolic related conditions. This mini-review investigates the link between NCDs and cognitive impairment through common risk factors. Identifying risk factors is important for the prevention and management of these chronic conditions. In addition, this review also identifies the role of primary health care services in reducing behavioral risk factors for NCDs and cognitive impairment. Addressing shared determinants and pathways is important in the design of public health interventions and primary health care services in China. Monitoring and management of NCD biomarkers and behavioral risk factors may also be beneficial for cognitive health among older Chinese.

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The development of a competency assessment standard for general practitioners in China

- Rao, Xin, Lai, Jinming, Wu, Hua, Li, Yang, Xu, Xingzhi, Browning, Colette, Thomas, Shane

Authors: Rao, Xin , Lai, Jinming , Wu, Hua , Li, Yang , Xu, Xingzhi , Browning, Colette , Thomas, Shane
Date: 2020
Type: Text , Journal article
Relation: Frontiers in Public Health Vol. 8, no. (2020), p.
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Description: This paper describes the development of a competency assessment standard for General Practitioners in Shenzhen, China. The standard is to be used for developing and delivering the training curriculum for General Practitioners and to enable rigorous assessment of the mastery of the standards by GP trainees. The requirement for the training of General Practitioners in China is mandated by government policy requires an international standard curriculum to meet the needs of patients and the community. A modified Delphi process was employed to arrive at a curriculum consensus. An expert panel and 14 expert working groups derived from the expert panel were established to review and evaluate national and international competency standards for General Practice and develop a set of standards, through a modified Delphi methodology. Forty three experts were involved in the project. The project resulted in a detailed curriculum statement. The curriculum was then used in 2017 and 2018 where pilot examinations of GP trainees (n = 298 and n = 315, respectively) were conducted to assess the trainee's competencies against the Standards. The examination included two modules, a written test (Module A) and a practical test (Module B). The success rate for participants was relatively low with the majority not successfully completing the assessments. The assessments will be further refined in subsequent work. The project achieved its goal of developing a rigorously evaluated standard to support clinical practice and the training and assessment of GPs. © Copyright © 2020 Rao, Lai, Wu, Li, Xu, Browning and Thomas.

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Older women in australia : facing the challenges of dual sensory loss

- Heine, Chyrisse, Gong, Cathy, Feldman, Susan, Browning, Colette

Authors: Heine, Chyrisse , Gong, Cathy , Feldman, Susan , Browning, Colette
Date: 2020
Type: Text , Journal article
Relation: International Journal of Environmental Research and Public Health Vol. 17, no. 1 (2020), p.
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Description: With the increase in longevity, the number of women living into old age is rising and higher than that of men. Data was derived from the Melbourne Longitudinal Studies on Healthy Ageing Program, which included 533 women and 467 men aged 65 years and older, in Australia, over 10 years. Logistic regression modeling was used to investigate the prevalence of dual sensory loss and the unmet needs for vision and hearing devices in older women (compared to men) over time, as well as its impacts on self-reported general health, depression, perceived social activities, community service use and ageing in place. Results suggested that the prevalence of dual sensory loss increased for women from the age of 75 years and over. Dual sensory loss was higher for older women and men who were living alone, with government benefits as their main income source or were divorced, separated or widowed. Dual sensory loss had significant impacts on poor general health, perceived inadequate social activities and community service use for women and men and on depression for women only. Early identification of dual sensory loss is essential to minimize its effects, ensuring continued well-being for this population. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Ageing in Australia - Challenges and Opportunities

- O'Loughlin, Kate, Browning, Colette, Kendig, Hal

Authors: O'Loughlin, Kate , Browning, Colette , Kendig, Hal
Date: 2017
Type: Text , Book
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Description: This stimulating volume examines the many faces of Australias ageing population, the social and health issues they contend with, and the steps being takenand many that should be takento help ensure a more positive and productive later life. Individual and societal ageing are conceptualized as developmental in nature, socially diverse, and marked by daily life challenges stemming from the countrys economic structures, attitudes, geography, political landscape, and infrastructure. Wide-ranging coverage (e.g., health, inequalities, employment, transportation) assesses options available to older people, and the role of families, employers, service providers, government agencies, and others in promoting or expanding those choices. The books double emphasis on challenges in older peoples lives and opportunities for enhancing their quality of life is on clear display as case studies examine policy issuesand propose solutionsin a societal and individual context. Included in the coverage: · Australian developments in ageing: issues and history · Cultural diversity, health, and ageing · Indigenous Australians and ageing: responding to diversity in policy and practice · Enhancing the health and employment participation of older workers · Housing and the environments of ageing · Health services and care for older people The rich examples in Ageing in Australia contain a depth of understanding and evidence for sociologists, gerontologists and psychologists studying ageing, health care professionals providing care to older people, and policy analysts assessing areas for improvement.

Trajectories of ageing well among older Australians : a 16-year longitudinal study

- Browning, Colette, Enticott, Joanne, Thomas, Shane, Kendig, Hal

Authors: Browning, Colette , Enticott, Joanne , Thomas, Shane , Kendig, Hal
Date: 2018
Type: Text , Journal article
Relation: Ageing and Society Vol. 38, no. 8 (2018), p. 1581-1602
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Description: In this study we used individual differences concepts and analyses to examine whether older people achieve different ageing-well states universally or whether there are identifiable key groups that achieve them to different extents. The data used in the modelling were from a prospective 16-year longitudinal study of 1,000 older Australians. We examined predictors of trajectories for ageing well using self-rated health, psychological wellbeing and independence in daily living as joint indicators of ageing well in people aged over 65 years at baseline. We used group-trajectory modelling and multivariate regression to identify characteristics predicting 'ageing well'. The results showed three distinct and sizeable ageing trajectory groups: (a) 'stable-good ageing well' (classified as ageing well in all longitudinal study waves; which was achieved by 30.2% of women and 28.0% of men); (b) 'initially ageing well then deteriorating' (50.5% women and 47.6% men); and (c) 'stable-poor' (not ageing well in any wave; 19.3% women and 24.4% men). Significant gender differences were found in membership in different ageing-well states. In the stable-poor groups there were 103/533 females which was significantly lower than 114/467 men (z-statistic = -2.6, p = 0.005); women had a 'zero' probability of progressing to a better ageing-well classification in later years, whilst males had a one-in-five probability of actually improving. Robust final state outcome predictors at baseline were lower age and fewer medical conditions for both genders; restful sleep and Australian-born for women; and good nutrition, decreased strain, non-smoker and good social support for men. These results support that ageing-well trajectories are influenced by modifiable factors. Findings will assist better targeting of health-promoting activities for older people. © Cambridge University Press 2017.

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Effect of a health coach intervention for the management of individuals with type 2 diabetes mellitus in China : a pragmatic cluster randomized controlled trial

- Chapman, Anna, Browning, Colette, Enticott, Joanne, Yang, Hui, Liu, Shuo, Zhang, Tuohong, Thomas, Shane

Authors: Chapman, Anna , Browning, Colette , Enticott, Joanne , Yang, Hui , Liu, Shuo , Zhang, Tuohong , Thomas, Shane
Date: 2018
Type: Text , Journal article
Relation: Frontiers in Public Health Vol. 6, (2018)
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Description: Aim: To determine the effect of a health coach intervention for the management of glycemic control, as well as physiological, psychological and self-care outcomes of patients with type 2 diabetes mellitus (T2DM), compared with usual care. Methods:This pragmatic cluster RCT was conducted in the Fengtai district of Beijing from August 2011 to December 2013. Forty-one community health stations (CHSs) were cluster randomized (stratified geographically, 1:1 ratio) and eligible, randomly selected T2DM patients were sequentially contacted by CHSs. Control participants received usual care according to the Chinese Guideline for Diabetes Prevention and Management. Intervention participants received 18-months of health coaching based on principles of Motivational Interviewing (MI) plus usual care. Medical and pathology fees were waived for both groups. Outcome assessment was performed at baseline, 6, 12, and 18-months. The primary outcome was glycated hemoglobin (HbA1c); secondary outcomes encompassed a suite of physiological, psychological and self-care measures. Results:No differential treatment effect was found at 18-months for HbA1c (adj. difference -0.07, 95% CI -0.53 to 0.39, p = 0.769) or any specified secondary outcomes. Interestingly, both groups displayed a statistically and clinically significant within-group improvement of the same magnitude at 18-months for HbA1c (intervention: mean change -3.65, 95% CI -3.92 to -3.37; control: mean change -3.38, 95% CI -3.67 to -3.08). Conclusions:The lack of differential treatment effects observed indicate that it may be premature to recommend the routine delivery of health coach interventions based on MI principles for the management of T2DM in China. However, the large, comparable within-group improvement in mean HbA1c promotes the establishment of free, regular clinical health assessments for individuals with T2DM in China. © 2018 Chapman, Browning, Enticott, Yang, Liu, Zhang and Thomas.

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Management of type 2 diabetes in China : the happy life club, a pragmatic cluster randomised controlled trial using health coaches

- Browning, Colette, Chapman, Anna, Yang, Hui, Liu, Shuo, Zhang, Tuohong, Enticott, Joanne, Thomas, Shane

Authors: Browning, Colette , Chapman, Anna , Yang, Hui , Liu, Shuo , Zhang, Tuohong , Enticott, Joanne , Thomas, Shane
Date: 2016
Type: Text , Journal article
Relation: BMJ Open Vol. 6, no. 3 (2016), p.
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Description: Objective: To assess the effectiveness of a coach-led motivational interviewing (MI) intervention in improving glycaemic control, as well as clinical, psychosocial and self-care outcomes of individuals with type 2 diabetes mellitus (T2DM) compared with usual care. Design: Pragmatic cluster randomised controlled trial (RCT). Setting: Community Health Stations (CHSs) in Fengtai district, Beijing, China. Participants: Of the 41 randomised CHSs (21 intervention and 20 control), 21 intervention CHSs (372 participants) and 18 control CHSs (296 participants) started participation. Intervention: Intervention participants received telephone and face-to-face MI health coaching in addition to usual care from their CHS. Control participants received usual care only. Medical fees were waived for both groups. Outcome measures: Outcomes were assessed at baseline, 6 and 12 months. Primary outcome measure was glycated haemoglobin (HbA1c). Secondary outcomes included a suite of anthropometric, blood pressure (BP), fasting blood, psychosocial and self-care measures. Results: At 12 months, no differential treatment effect was found for HbA1c (adjusted difference 0.02, 95% CI -0.40 to 0.44, p=0.929), with both treatment and control groups showing significant improvements. However, two secondary outcomes: psychological distress (adjusted difference -2.38, 95% CI -4.64 to -0.12, p=0.039) and systolic BP (adjusted difference -3.57, 95% CI -6.08 to -1.05, p=0.005) were robust outcomes consistent with significant differential treatment effects, as supported in sensitivity analyses. Interestingly, in addition to HbA1c, both groups displayed significant improvements in triglycerides, LDL cholesterol and HDL cholesterol. Conclusions: In line with the current Chinese primary healthcare reform, this study is the first large-scale cluster RCT to be implemented within real-world CHSs in China, specifically addressing T2DM. Although a differential treatment effect was not observed for HbA1c, numerous outcomes (including HbA1c) improved in both groups, supporting the establishment of regular, free clinical health checks for people with T2DM in China. Trial registration number: ISRCTN01010526; Preresults.

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Food, eating, and happy aging : the perceptions of older Chinese people

- Browning, Colette, Qiu, Zeqi, Yang, Hui, Zhang, Touhong, Thomas, Shane

Authors: Browning, Colette , Qiu, Zeqi , Yang, Hui , Zhang, Touhong , Thomas, Shane
Date: 2019
Type: Text , Journal article
Relation: Frontiers in Public Health Vol. 7, no. APR (2019), p.
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Description: China's government and its people have for a long time focused on food security for its population as one of the most important issues in economic and social development. Many older people in China have lived in times when food security was not stable. Thus, while food has a central position in Chinese culture for all Chinese people, it is of particular pertinence to older people. In this paper we explore the meaning of food and eating in the lives of older Chinese people in China and how it contributes to healthy, thus happy aging. Focus groups and qualitative interviews were used in this study. Participants were recruited from the rural Yongfu Province of Southwest China, and the urban Fangzhuang and Haidan districts in Beijing. Forty-two participants were recruited aged 62-83 years of age. All focus groups and interviews were conducted in Mandarin and audiotaped with the participants' permission. Audio-tapes were transcribed by a Chinese speaking researcher and then were translated into English. Data were analyzed continuously and comparatively, transcripts were coded, and themes and sub-themes were identified. The initial analysis and interpretation were then presented and discussed at a workshop with all the authors. Two major themes emerged-the quantity of food and the quality of food required to have a happy old age. Participants discussed the desire to eat "until you are full" because of their experiences of famine during childhood. However, they also believed that as an older person they should eat less for their health, particularly less high fat foods. The importance of the food quality and food affordability was also discussed. Grain and meat were characterized as "good" foods and important in their diets for a happy old age. The participants, especially those from urban areas, were concerned with food safety. The high cultural importance of food for older Chinese in China was confirmed in this study. Social and economic lifespan experiences continue to impact on the food and eating attitudes and practices of older Chinese. The food related life experiences of older Chinese in China are quite different from younger Chinese and health promotion messaging needs to be informed by these unique perspectives in order to maximize its effectiveness. © 2019 Browning, Qiu, Yang, Zhang and Thomas.

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Barriers and enablers to the delivery of psychological care in the management of patients with type 2 diabetes mellitus in China : a qualitative study using the theoretical domains framework

- Chapman, Anna, Yang, Hui, Thomas, Shane, Searle, Kendall, Browning, Colette

Authors: Chapman, Anna , Yang, Hui , Thomas, Shane , Searle, Kendall , Browning, Colette
Date: 2016
Type: Text , Journal article
Relation: BMC Health Services Research Vol. 16, no. 1 (2016), p.
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Description: Background: China has the largest number of type 2 diabetes mellitus (T2DM) cases globally and individuals with T2DM have an increased risk of developing mental health disorders and functional problems. Despite guidelines recommending that psychological care be delivered in conjunction with standard T2DM care; psychological care is not routinely delivered in China. Community Health Centre (CHC) doctors play a key role in the management of patients with T2DM in China. Understanding the behavioural determinants of CHC doctors in the implementation of psychological care recommendations allows for the design of targeted and culturally appropriate interventions. As such, this study aimed to examine barriers and enablers to the delivery of psychological care to patients with T2DM from the perspective of CHC doctors in China. Methods: Two focus groups were conducted with 23 CHC doctors from Shenzhen, China. The discussion guide applied the Theoretical Domains Framework (TDF) that examines current practice and identifies key barriers and enablers perceived to influence practice. Focus groups were conducted with an interpreter, and were digitally recorded and transcribed. Two researchers independently coded transcripts into pre-defined themes using deductive thematic analysis. Results: Barriers and enablers perceived by doctors as being relevant to the delivery of psychological care for patients with T2DM were primarily categorised within eight TDF domains. Key barriers included: CHC doctors' knowledge and skills; time constraints; and absence of financial incentives. Other barriers included: societal perception that treating psychological aspects of health is less important than physical health; lack of opinion leaders; doctors' intentional disregard of psychological care; and doubts regarding the efficacy of psychological care. In contrast, perceived enablers included: Training of CHC doctors in psychological skills; identification of afternoon/evening clinic times when recommendations could be implemented; introduction of financial incentives; and the creation of a professional role (e.g. diabetes educator), that could implement psychological care recommendations to patients with T2DM. © 2016 Chapman et al..

Primary health care and older people

- Browning, Colette, Davis, Jenny, Thomas, Shane

Authors: Browning, Colette , Davis, Jenny , Thomas, Shane
Date: 2016
Type: Text , Book chapter
Relation: Ageing in Australia: Challenges and Opportunities p. 225-237
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Description: This chapter examines the role of primary health care in the health of older people. As background to the chapter we discuss how primary health care operates in Australia, the workforce challenges and the recent policy reforms. Next we discuss primary health care use by older Australians and the types of services accessed. A main theme in the chapter is the lack of co-ordination between the health and aged care system in the delivery of primary health care services to older people, and the need for integrated care that addresses issues of multi-morbidity and multi-professional input to the care of older people. Addressing these issues through a skilled workforce, better communication between health professionals and a funding approach that does not disadvantage older multiple users of the primary health care system, will assist in the prevention of entry of older people into the more expensive secondary and tertiary health care and residential aged care systems.

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Cognitive distortions among older adult gamblers in an Asian context

- Subramaniam, Mythily, Chong, Siow, Browning, Colette, Thomas, Shane

Authors: Subramaniam, Mythily , Chong, Siow , Browning, Colette , Thomas, Shane
Date: 2017
Type: Text , Journal article
Relation: PLoS ONE Vol. 12, no. 5 (2017), p.
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Description: Aims: The study aims to describe the construct of cognitive distortions based on the narratives of older adult gamblers (aged 60 years and above) in Singapore. Methods: Singapore residents (citizens or permanent residents) aged 60 years and above, who were current or past regular gamblers were included in the study. Participants were recruited using a combination of venue based approach, referrals from service providers as well as by snowball sampling. In all, 25 in-depth interviews were conducted with older adult gamblers. The six-step thematic network analysis methodology was adopted for data analysis. Results: The mean age of the participants was 66.2 years. The majority were male (n = 18), of Chinese ethnicity (n = 16), with a mean age of gambling initiation at 24.5 years. Among older adult gamblers, cognitive distortions emerged as a significant global theme comprising three organizing themes-illusion of control, probability control and interpretive control. The organizing themes comprised nine basic themes: perception of gambling as a skill, near miss, concept of luck, superstitious beliefs, entrapment, gambler's fallacy, chasing wins, chasing losses, and beliefs that wins are more than losses. Conclusions: Cognitive distortions were endorsed by all gamblers in the current study and were shown to play a role in both maintaining and escalating the gambling behaviour. While the surface characteristics of the distortions had a culture-specific appearance, the deeper characteristics of the distortions may in fact be more universal than previously thought. Future research must include longitudinal studies to understand causal relationships between cognitive distortions and gambling as well as the role of culture-specific distortions both in the maintenance and treatment of the disorder. © 2017 Subramaniam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Gambling and family : a two-way relationship

- Subramaniam, Mythily, Chong, Siow, Satghare, Pratika, Browning, Colette, Thomas, Shane

Authors: Subramaniam, Mythily , Chong, Siow , Satghare, Pratika , Browning, Colette , Thomas, Shane
Date: 2017
Type: Text , Journal article
Relation: Journal of Behavioral Addictions Vol. 6, no. 4 (2017), p. 689-698
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Description: Background and aims: Families play an important role in the evolution of gambling and are also adversely affected by the disordered gambling of any one of their members. The aims of this study were to explore both the role families play in gambling initiation, maintenance, and help-seeking, and the harm caused to families by the gambling behavior using a qualitative approach. Methods: Regular older adult gamblers were included in the study. In-depth interviews were conducted with 25 older adults to gain an understanding of gambling from their perspective. Older adult gamblers described their lived experience of gambling ranging from initiation to harm and attempts to cut down or limit gambling. Data were analyzed using thematic network analysis. Results: The mean age of the 25 participants was 66.2 years. The majority were male (n = 18), of Chinese ethnicity (n = 16), had secondary education (n = 9), were married (n = 20), and currently employed (n = 15). Four organizing themes related to the role of families in initiation and maintenance of gambling, harm caused to family members, and their role in help-seeking were identified. Discussion and conclusions: The study emphasizes the role of Asian families in both initiation and maintenance of gambling. Hence, families must be involved in prevention and outreach programs. Family members must be educated, so that they can encourage help-seeking to ensure early treatment and recovery. There is a need for interventional studies for reducing stress and improving coping among family members. © 2017 The Author(s).

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Responsible gambling among older adults : a qualitative exploration

- Subramaniam, Mythily, Satghare, Pratika, Vaingankar, Janhavi, Picco, Louisa, Browning, Colette, Chong, Siow, Thomas, Shane

Authors: Subramaniam, Mythily , Satghare, Pratika , Vaingankar, Janhavi , Picco, Louisa , Browning, Colette , Chong, Siow , Thomas, Shane
Date: 2017
Type: Text , Journal article
Relation: BMC Psychiatry Vol. 17, no. 1 (2017), p.
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Description: Background: Responsible gambling (RG) is defined as gambling for pleasure and entertainment but with an awareness of the likelihood of losing, an understanding of the associated risks and the ability to exercise control over one's gambling activity. The current study describes a qualitative approach to explore RG among older adults (aged 60 years and above) in Singapore and reports on the cognitive and behavioural strategies employed by them to regulate their gambling. Methods: Inclusion criteria included Singapore residents aged 60 years and above, who could speak in English, Chinese, Malay or Tamil and were current or past regular gamblers. Participants were recruited using a combination of network and purposive sampling. Socio-demographic information on age, age of onset of gambling, gender, ethnicity, marital status, education and employment was collected. The South Oaks Gambling Screen (SOGS) was used to collect information on gambling activities and problems associated with gambling behaviour. Qualitative interviews were conducted with 25 older adults (60 years and above) who currently gambled. The data was analyzed using thematic network analysis. Results: This global theme of RG comprised two organising themes: self -developed strategies to limit gambling related harm and family interventions to reduce gambling harm. The basic themes included delayed gratification, perception of futility of gambling, setting limits, maintaining balance, help-seeking and awareness of disordered gambling in self or in others. Family interventions included pleading and threatening, compelling help-seeking as well as family exclusion order. Conclusions: The study highlights the significant role that families play in Asian societies in imposing RG. Education of family members both in terms of the importance of RG, and communication of the ways in which older adults can incorporate RG behaviours including the use of exclusion in specific scenarios is important. © 2017 The Author(s).

Beyond crisis : enacted sense-making among ethnic minority carers of people with dementia in Australia

- Brijnath, Bianca, Gilbert, Andrew, Kent, Mike, Ellis, Katie, Browning, Colette

Authors: Brijnath, Bianca , Gilbert, Andrew , Kent, Mike , Ellis, Katie , Browning, Colette
Date: 2021
Type: Text , Journal article
Relation: Dementia Vol. 20, no. 6 (2021), p. 1910-1924
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Description: The ‘family crisis’ narrative is frequently used in dementia studies to explain ethnic minority families’ pathways to health and aged care and why there is delayed dementia diagnoses in ethnic minority communities. Such narratives may obscure the family carers’ agency in negotiating services and managing personal, social and structural burdens in the lead up to diagnosis. To illuminate agency, this article describes ethnic minority families’ pathways to a dementia diagnosis using the concept of sense-making. Three case studies were drawn from 56 video interviews with family carers of older adults with dementia from Chinese, Arab and Indian backgrounds. Interviews were conducted across Australia from February to August 2018, then translated, transcribed and thematically analysed. Findings suggest families did not enter into formal care because of a crisis, instead navigating fragmented systems and conflicting advice to obtain a dementia diagnosis and access to relevant care. This experience was driven by sense-making (a search for plausible explanations) that involved family carers interpreting discrepant cues in changes to the behaviour of the person with dementia over time, managing conflicting (medical) advice about these discrepancies and reinterpreting their relationships with hindsight. The sense-making concept offers a more constructive hermeneutic than the ‘family crisis’ narrative as it illuminates the agency of carers’ in understanding changed behaviours, negotiating services and managing personal, social and structural barriers pre-diagnosis. The concept also demonstrates the need for a multimodal approach to promoting timely diagnosis of dementia in ethnic minority communities through dementia awareness and literacy campaigns as well as initiatives that address structural inequities. © The Author(s) 2020. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Colette Browning” is provided in this record**

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The inter-relationship of diversity principles for the enhanced participation of older people in their care : a qualitative study

- Ogrin, Rajna, Meyer, Claudia, Appannah, Arti, McMillan, Sally, Browning, Colette

Authors: Ogrin, Rajna , Meyer, Claudia , Appannah, Arti , McMillan, Sally , Browning, Colette
Date: 2020
Type: Text , Journal article
Relation: International Journal for Equity in Health Vol. 19, no. 1 (2020), p.
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Description: Background: The health and aged care workforce must understand and support the diverse needs of older people to enhance their care experience. We previously identified five principles of diversity training for this workforce: awareness of unconscious bias and prejudice; promotion of inclusion; access and equity; appropriate engagement; and intersectionality. This study aims to explore how these principles are considered from the perspectives of older Australians. Methods: Older people (≥65 years) receiving home care and nursing services based in Victoria, Australia were invited to participate in a home-based semi-structured interview about their experience of, or with, diversity. Interviews were thematically analysed using a priori categories based on our previous work on principles of diversity training, and themes were interpreted and expanded upon based on the participants' experiences and understanding of diversity concepts and their care needs. Results: Fifteen older people (seven female, eight male), mean age 76 years (range 71-85 years), were interviewed. Five themes were drawn from the data. It was found that human connection through building (1) trust and rapport was highly valued as an approach by older people, crucial as a first step to understanding what is important to the older person. Identifying with (2) intersectionality, that is, the different intersecting aspects of who they are and their experiences was understood by the participants as an important framework to meet their needs. The participants were aware of (3) unconscious bias and prejudice by health professionals and its impact on their care. Participants also noted that (4) promotion of inclusion through language was important to for a positive relationship with the healthcare worker. The participants understood that to facilitate human connection, these four principles of human interaction were critical, underpinned by (5) access and equity of the system. A model articulating these relationships was developed. Conclusion: Health and aged care training should incorporate the five diversity principles to support older people to participate in their own care. © 2020 The Author(s).

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