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Dr Michelle DiGiacomo

Biography

Dr DiGiacomo leads the Reducing Health and Social Disparities stream in the Centre. Her program of research appreciates the contexts within which individuals, families, and communities negotiate, cope, and adjust to living with chronic conditions. She endeavours to underscore the importance and utility of tailoring health service initiatives to meet the diverse needs and preferences of individuals and groups.  She applies her background in organisational and health psychology to research on the interface of health services and vulnerable populations, particularly in respect of access and appropriateness of care. 

She has worked with the Chronic Care Team at the Aboriginal Medical Service Western Sydney since 2005 on a smoking cessation program and a range of other health initiatives.  She has undertaken consultancy work for the Cancer Council’s Aboriginal and Torres Strait Islander Sub-committee, National Heart Foundation (NSW) and TAFE (NSW), the World Health Organisation Collaborating Centre for Nursing, Midwifery and Health Development, and several NSW Area Health Services.

Professional

  • Deputy Editor, Journal of Smoking Cessation

Image of Michelle DiGiacomo
Senior Research Fellow, Faculty of Health
Research Fellow, Centre for Cardiovascular and Chronic Care (CCCC)
Associate Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Core Member, Health Services and Practice Research Strength
Bachelor of Arts (UMASS), Master of Health Science (Hons) (USyd), PhD (USyd)
Member, Australian Psychological Society
 
Phone
+61 2 9514 4818
Room
CB10.07.234

Research Interests

  • Reducing health and social disparities
  • Access and appropriateness of health services
  • Vulnerable populations living with chronic conditions
  • Coping and adjusting
  • Smoking cessation 
  • Behaviour change
  • Secondary prevention
  • Social determinants of health
  • Palliative care
Can supervise: Yes
  • Culturally and linguistically diverse peoples living with chronic conditions
  • Cardiovascular disease in women
  • Health and wellbeing of older women (including spousal bereavement)
  • Aboriginal families' journey to support in childhood disability
  • Smoking cessation in Aboriginal people
  • Palliative care in people facing social and economic disadvantage
  • Health Promotion
  • Qualitative Research
  • Epidemiology and Population Health
  • Evidence-based Practice
  • Non-Communicable Disease 
  • Building Personal & Professional Resilience

Chapters

Halcomb, E., Gholizadeh, L., DiGiacomo, M., Phillips, J.L. & Davidson, P.M. 2012, 'Considerations in undertaking focus group research with culturally and linguistically diverse groups in Bibliographies and Literature Reviews' in Walden, G.R. (ed), Focus Group Research, part of the SAGE Benchmarks in Social Research Methods, Sage, UK, pp. 1-17.
Focus groups are a popular, widely accepted, and legitimate research method to determine attitudes, experiences, perceptions, and knowledge on a wide range of topics in many fields of endeavor. Focus groups lead to the voicing of attitudes and insights not readily attainable from other qualitative forms of data collection. The spectrum of interest in focus groups covers virtually all disciplines, and the variety of the applications for this technique is extraordinary. As part of the SAGE Benchmarks in Social Research Methods series, Graham Walden explores what a focus group is, how they are best used, the strengths and weaknesses of focus groups and the ethical issues surrounding focus groups, amongst other things. Volume 2, Part 2, 'Bibliographies and Literature Reviews' contains Halcomb et al.'s "Considerations in undertaking focus group research with culturally and linguistically diverse groups". URL: http://www.sagepub.com/books/Book235672/toc

Conferences

Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2014, 'Disease Management Interventions For Improving Self-Management In Lower-Limb Peripheral Arterial Disease: A Cochrane Review.', Global Heart Supplements, Elsevier, US, p. e262.
Cao, Y., Davidson, P.M., Digiacomo, M. & Yang, M. 2010, 'A Global Problem but of Concern in Mainland China: Pre-Hospital Delay for Acute Coronary Syndrome', CIRCULATION, pp. E125-E125.

Journal articles

Sayers, J., Salamonson, Y., DiGiacomo, M. & Davidson, P.M. 2015, 'Role ambiguity and job satisfaction of nurse educators in Australia', Journal of Nurse Education and Practice, vol. 5, no. 4, pp. 41-51.
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Purpose: The purpose of this study was to describe the nurse educator role in Australian hospitals, including their practice and performance standards. Methods: A cross-sectional, online survey of nurse educators employed in acute care hospitals in Australia was administered over a three-month period. The survey comprised established and researcher-developed scales, and a single open-ended question. Quantitative data was analysed using descriptive statistics. Qualitative data was analysed using a general inductive approach. Results: Nurse educators who were more likely to fulfill nurse educator competency practice domains had masters degrees in education, defined professional development needs, and met regularly with their managers. These educators also had higher levels of job satisfaction. Participants identified that role ambiguity and role confusion adversely impacted nurse educator role expectations, responsibilities, and job satisfaction. Despite this, the majority of educators intended to stay in their role for the foreseeable future. Conclusions: Role ambiguity influenced professional identity and job satisfaction, highlighting the need for clarification of nurse educator roles. These findings suggest the need for review of the nurse educator role and incorporation of professional and educational requirements and practice competencies. Ongoing role monitoring is recommended to identify the effects of role change.
Maneze, D., DiGiacomo, M., Salamonson, Y., Descallar, J. & Davidson, P.M. 2015, 'Facilitators and Barriers to Health-Seeking Behaviours among Filipino Migrants: Inductive Analysis to Inform Health Promotion', Biomed Research International, vol. In press.
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Understanding factors that influence health-seeking behaviour of migrants is necessary to intervene for behaviour change. This paper explores Filipino migrants perceptions of facilitators and barriers to maintaining health in Australia. Open-ended survey item responses reflecting factors that assisted and hindered health following migration to Australia were inductively analysed. Three hundred and thirty-seven of the 552 survey respondents (61%) provided open-ended responses. Responses were grouped into two major categories: individual factors, including personal resources and cultural influences, and environmental factors encompassing both the physical conditions in the host country and health service access. Awareness of practices that enhance health was a major personal facilitator of health-seeking behaviour; however, competing priorities of daily living were perceived as barriers. Cultural beliefs and practices influenced health-seeking behaviour. Despite high self-rated English language skills in this population, new migrants and the elderly cited communication difficulties as barriers to accessing health services. Insight into facilitators and barriers to health-seeking behaviour in this less researched migrant population revealed tools for enhancing engagement in health promotion programs addressing healthy lifestyle.
Thompson, S.C., Shahid, S., Digiacomo, M., Pilkington, L. & Davidson, P.M. 2014, 'Making progress: The role of cancer councils in Australia in indigenous cancer control', BMC Public Health, vol. 14, no. 1.
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Background: Indigenous Australians have poorer outcomes from cancer for a variety of reasons including poorer participation in screening programs, later diagnosis, higher rates of cancer with poor prognosis and poorer uptake and completion of treatment. Cancer prevention and support for people with cancer is part of the core business of the State and Territory Cancer Councils. To support sharing of lessons learned, this paper reports an environmental scan undertaken in 2010 in cancer councils (CCs) nationwide that aimed to support Indigenous cancer control. Methods. The methods replicated the approach used in a 2006 environmental scan of Indigenous related activity in CCs. The Chief Executive Officer of each CC nominated individuals for interview. Interviews explored staffing, projects, programs and activities to progress cancer control issues for Indigenous Australians, through phone or face-to-face interviews. Reported initiatives were tabulated using predetermined categories of activity and summaries were returned to interviewees, the Aboriginal and Torres Strait Islander Subcommittee and Chief Executive Officers for verification. Results: All CCs participated and modest increases in activity had occurred in most states since 2006 through different means. Indigenous staff numbers were low and no Indigenous person had yet been employed in smaller CCs; no CC had an Indigenous Board member and efforts at capacity building were often directed outside of the organisation. Developing partnerships with Indigenous organisations were ongoing. Acknowledgement and specific mention of Indigenous people in policy was increasing. Momentum increased following the establishment of a national subcommittee which increased the profile of Indigenous issues and provided collegial and practical support for those committed to reducing Indigenous cancer disparities. Government funding of "Closing the Gap" and research in the larger CCs have been other avenues for increasing knowledge...
Al Abed, N.A., Hickman, L., Jackson, D., DiGiacomo, M. & Davidson, P.M. 2014, 'Older Arab migrants in Australia: Between the hammer of prejudice and the anvil of social isolation', Contemporary Nurse, vol. 46, no. 2, pp. 259-262.
Moscou-Jackson, G., Commodore-Mensah, Y., Farley, J. & DiGiacomo, M. 2014, 'Smoking-Cessation Interventions in People Living With HIV Infection: A Systematic Review', Journal of the Association of Nurses in AIDS Care, vol. 25, no. 1, pp. 32-45.
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Tobacco smoking remains a prevalent behavior in people living with HIV infection (PLWHs) and is associated with impaired immune functioning, increased cardiovascular risk, and decreased response to antiretroviral therapy. This review presents a critique and synthesis of evidence on effective smoking-cessation interventions for PLWHs. A comprehensive search identified nine peer-reviewed intervention studies published between 1989 and 2012. The highest likelihood of smoking cessation (range of odds ratios 4.33-5.6) were in two randomized controlled trial interventions using cell phone technology. Clinically significant reductions in systolic blood pressure, weight gain, and increased CD4+ T-cell count were reported in participants who ceased smoking in three of the nine studies. Overall, multistrategy smoking-cessation interventions, delivered over multiple sessions, were effective. However, the most effective interventions were tailored to the unique individual needs of PLWHs, including assessment of and intervention for polysubstance abuse and mental health issues, as well as the inclusion of access-promoting elements. 2014 Association of Nurses in AIDS Care.
Lewis, J.M., Digiacomo, M., Currow, D.C. & Davidson, P.M. 2014, 'Social capital in a lower socioeconomic palliative care population: A qualitative investigation of individual, community and civic networks and relations', BMC Palliative Care, vol. 13, no. 1.
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Background: Lower socioeconomic populations live and die in contexts that render them vulnerable to poorer health and wellbeing. Contexts of care at the end of life are overwhelmingly determined by the capacity and nature of formal and informal networks and relations to support care. To date, studies exploring the nature of networks and relations of support in lower socioeconomic populations at the end of life are absent. This qualitative study sought to identify the nature of individual, community and civic networks and relations that defined the contexts of care for this group. Methods. Semi-structured qualitative interviews were conducted with 16 patients and 6 informal carers who identified that they had social and economic needs and were from a lower socioeconomic area. A social capital questionnaire identifying individual, community and civic networks and relations formed the interview guide. Interviews were audio-taped, transcribed and analysed using framework analysis. Results: Participants identified that individual and community networks and relations of support were mainly inadequate to meet care needs. Specifically, data revealed: (1) individual (informal caregivers) networks and relations were small and fragile due to the nature of conflict and crisis; (2) community trust and engagement was limited and shifted by illness and caregiving; (3) and formal care services were inconsistent and provided limited practical support. Some transitions in community relations for support were noted. Levels of civic and government engagement and support were overall positive and enabled access to welfare resources. Conclusion: Networks and relations of support are essential for ensuring quality end of life care is achieved. Lower socioeconomic groups are at a distinct disadvantage where these networks and relations are limited, as they lack the resources necessary to augment these gaps. Understanding of the nature of assets and limitations, in networks and relations...
Deek, H., Abbott, P., Moore, L., Davison, J., Cameron, S., Digiacomo, M., McGrath, S.J., Dharmendra, T. & Davidson, P.M. 2014, 'Pneumococcus in Aboriginal and Torres Strait Islanders: the role of Aboriginal Health Workers and implications for nursing practice.', Contemp Nurse.
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Abstract Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and grey literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
Green, A., DiGiacomo, M., Luckett, T., Abbott, P., Davidson, P., Delaney, J. & Delaney, P. 2014, 'Cross-sector collaborations in Aboriginal and Torres Strait Islander childhood disability: a systematic integrative review and theory-based synthesis.', Int J Equity Health, vol. 13, no. 1, p. 126.
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IntroductionAboriginal and Torres Strait Islander children in Australia experience a higher prevalence of disability and socio-economic disadvantage than other Australian children. Early intervention is vital for improved health outcomes, but complex and fragmented service provision impedes access. There have been international and national policy shifts towards inter-sector collaborative responses to disability, but more needs to be known about how collaboration works in practice.MethodsA systematic integrative literature review using a narrative synthesis of peer-reviewed and grey literature was undertaken to describe components of inter- and intra-sector collaborations among services to Aboriginal and Torres Strait Islander children with a disability and their families. The findings were synthesized using the conceptual model of the ecological framework.ResultsThirteen articles published in a peer-reviewed journal and 18 articles from the grey literature met inclusion criteria. Important factors in inter- and intra-sector collaborations identified included: structure of government departments and agencies, and policies at the macro- (government) system level; communication, financial and human resources, and service delivery setting at the exo- (organizational) system level; and relationships and inter- and intra-professional learning at the meso- (provider) system level.ConclusionsThe policy shift towards inter-sector collaborative approaches represents an opportunity for the health, education and social service sectors and their providers to work collaboratively in innovative ways to improve service access for Aboriginal and Torres Strait Islander children with a disability and their families. The findings of this review depict a national snapshot of collaboration, but as each community is unique, further research into collaboration within local contexts is required to ensure collaborative solutions to improve service access are responsive to local needs and...
Davidson, P.M., DiGiacomo, M. & Jackson, D.E. 2013, 'Enriching doctoral education with student diversity', Advances in Nursing Doctoral Education and Research, vol. 1, no. 1, pp. 10-16.
This article seeks to identify factors to be considered in embracing perspectives of diversity in doctoral programs from the perspective of the extant literature and personal reflec-tion of experienced supervisors
Lewis, J.M., Digiacomo, M., Luckett, T., Davidson, P.M. & Currow, D.C. 2013, 'A social capital framework for palliative care: Supporting health and well-being for people with life-limiting illness and their carers through social relations and networks', Journal of Pain and Symptom Management, vol. 45, no. 1, pp. 92-103.
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Context: Social relations and networks are vital for sustaining and enhancing end-of-life care. The social capital concept supports a framework to understand the association between social relations and well-being; yet, to date, there has been very limited investigation of social capital in the palliative care literature. A framework for understanding social contexts in end-of-life care is necessary. Objectives: To summarize the literature on social capital, well-being, and quality of life for key outcomes to inform a model of social capital in palliative care. Methods: The electronic databases MEDLINE (1997 to March 2011), Embase (1997 to March 2011), CINAHL (1997 to March 2011), and PsycINFO (1997 to March 2011) were searched using key/MeSH search terms of "social capital," "palliative care," and "well-being" and/or "quality of life." The literature was reviewed to identify key concepts to develop and inform a palliative care social capital framework. Results: A total of 93 articles were included in the literature review, with only two articles identifying discourse on social capital and palliative care. Four key areas integrating the social capital outcomes informed a framework for palliative care. Conclusion: The social capital concept provides a structure for understanding how the organization and meaning of social contexts can potentially enhance or hinder end-of-life care. Research that identifies specificity in application of social capital concepts is fundamental to issues of access to services, sustaining levels of care, quality of life, and well-being. The importance of "bridged" social capital relations and networks for improved resource acquisition and information flow was identified in the literature and outlined within the palliative care social capital framework. Differential access to social capital by disadvantaged groups provides further impetus to engage a model of social capital for palliative care. 2013 Published by Elsevier Inc. on behalf...
Perera, H.N. & DiGiacomo, M. 2013, 'The relationship of trait emotional intelligence with academic performance: A meta-analytic review', Learning and Individual Differences, vol. 28, pp. 20-33.
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This article reports results of a meta-analysis that aimed to assess the validity of trait emotional intelligence (trait EI) for predicting academic performance. Seventy-four effect sizes were drawn from 48 independent samples with a cumulative sample size of 10,292. A meta-analysis with random-effects weights yielded a modest-to-moderate, favorable validity coefficient for trait EI (r= .20, 95% CI. = .16-.24). Homogeneity analysis revealed substantial heterogeneity in the effects, indicating that within-study error alone could not sufficiently explain the variability in effect size estimates. Tests of moderation showed that the summary effect increased as a function of decreasing age and academic level. The finding of favorable validity for trait EI suggests that researchers should reconsider the theoretical bases on which extant postulations on the role of trait EI in academic performance are based. Possible explanations for moderator effects, limitations of this study, future directions and implications for education are discussed. 2013 Elsevier Inc.
DiGiacomo, M., Davidson, P.M., Byles, J. & Nolan, M.T. 2013, 'An Integrative and Socio-Cultural Perspective of Health, Wealth, and Adjustment in Widowhood', Health Care for Women International, vol. 34, no. 12, pp. 1067-1083.
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Women comprise a larger proportion of the ageing population than men, often outlive their spouses, and face a variety of challenges upon widowhood. Discrete aspects of the health impact of widowhood have been described in the literature; however, the expanse of sociocontextual issues that impact on older women's adjustment is less prominent. We undertook a literature review to synthesize recent research and interventions and identify current trends and gaps in knowledge and services. Although many health, social, cultural, and economic factors impact on recently widowed older women throughout the world, we found that few interventions targeting this population incorporate these factors. 2013 Copyright Taylor and Francis Group, LLC.
Digiacomo, M., Davidson, P.M., Abbott, P., Delaney, P., Dharmendra, T., McGrath, S.J., Delaney, J. & Vincent, F. 2013, 'Childhood disability in Aboriginal and Torres Strait Islander peoples: A literature review', International Journal for Equity in Health, vol. 12, no. 1.
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Introduction. Aboriginal and Torres Strait Islander children have higher rates of disability than non-Indigenous children and are considered doubly disadvantaged, yet there is very little data reflecting prevalence and service access to inform design and delivery of services. Failing to address physical, social, and psychological factors can have life-long consequences and perpetuate longstanding health disparities. Methods. A narrative literature review was undertaken to identify peer reviewed literature describing factors impacting on the prevention, recognition, and access to support and management of disability in Indigenous Australian children. Results: Twenty-seven peer-reviewed journal articles met inclusion criteria. The majority of articles focused on the hearing loss and learning disabilities consequent of otitis media. Few articles reported data on urban or metropolitan Indigenous populations or described interventions. Individual/community-, provider-, and systems level factors were identified as impacting on recognition and management of disability in young Indigenous children. Conclusions: Given the burden of childhood disability, the limited literature retrieved is concerning as this is a barometer of activity and investment. Solutions addressing childhood disability will require collaboration between health, social and educational disciplines as well as an increased investment in prevention, identification and promotion of access. 2013 DiGiacomo et al.; licensee BioMed Central Ltd.
Davidson, P.M., Jiwa, M., DiGiacomo, M.L., McGrath, S.J., Newton, P.J., Durey, A.J., Bessarab, D.C. & Thompson, S.C. 2013, 'The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery', Australian Health Review, vol. 37, no. 1, pp. 70-78.
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Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention. Method. Literature was sought via electronic database searches and journal hand-searching for the period from January 1995 to July 2010. Databases used included Indigenous HealthInfoNet, SCOPUS, PsycInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, HealthInsite and Google Scholar. Findings. Exposure to risk factors, cultural and spiritual values, remoteness and geographic characteristics, entrenched socioeconomic inequalities and racism contribute to reduced service access and poor outcomes. The review highlighted a complex interplay of individual, social, health system and environmental factors that impact on optimal lung cancer care and lung cancer outcomes. Considering the burden of lung cancer within a framework of social determinants of health is necessary for policy-making and service planning and delivery. Conclusions. It is imperative that the disproportionate burden of lung cancer in Aboriginal and Torres Strait Islander peoples is addressed immediately. Whilst strategic interventions in lung cancer prevention and care are needed, service providers and policy makers must acknowledge the entrenched inequality that exists and consider the broad range of factors at the patient, provider and system level. Primary care strategies and health promotion activities to reduce risk factors, such as smoking, must also be implemented, with Aboriginal and Torres Strait Islander peoples' engagement and control at the core of any strategy. This review has indicated that multifaceted interventions, supported by enabling policies that target individuals, communities and health prof...
Digiacomo, M., Delaney, P., Abbott, P., Davidson, P.M., Delaney, J. & Vincent, F. 2013, ''Doing the hard yards': Carer and provider focus group perspectives of accessing Aboriginal childhood disability services', BMC Health Services Research, vol. 13, no. 1.
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Background: Despite a high prevalence of disability, Aboriginal Australians access disability services in Australia less than non-Aboriginal Australians with a disability. The needs of Aboriginal children with disability are particularly poorly understood. They can endure long delays in treatment which can impact adversely on development. This study sought to ascertain the factors involved in accessing services and support for Aboriginal children with a disability. Methods. Using the focus group method, two community forums, one for health and service providers and one for carers of Aboriginal children with a disability, were held at an Aboriginal Community Controlled Health Service (ACCHS) in the Sydney, metropolitan area of New South Wales, Australia. Framework analysis was applied to qualitative data to elucidate key issues relevant to the dimensions of access framework. Independent coding consistency checks were performed and consensus of analysis verified by the entire research team, several of whom represented the local Aboriginal community. Results: Seventeen health and social service providers representing local area government and non-government-funded health and social service organisations and five carers participated in two separate forums between September and October 2011. Lack of awareness of services and inadequate availability were prominent concerns in both groups despite geographic proximity to a major metropolitan area with significant health infrastructure. Carers noted racism, insufficient or non-existent services, and the need for an enhanced role of ACCHSs and AHWs in disability support services. Providers highlighted logistical barriers and cultural and historical issues that impacted on the effectiveness of mainstream services for Aboriginal people. Conclusions: Despite dedicated disability services in an urban community, geographic proximity does not mitigate lack of awareness and availability of support. This paper has enumerated a num...
Digiacomo, M., Lewis, J., Nolan, M.T., Phillips, J. & Davidson, P.M. 2013, 'Transitioning from caregiving to widowhood', Journal of Pain and Symptom Management, vol. 46, no. 6, pp. 817-825.
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Context: Older women commonly assume a caregiving role for their husbands at the end of life and are more vulnerable to poorer health, well-being, and social and economic challenges. Objectives: The aim of this study was to ascertain older women's experiences of spousal caregiving at the end of life and the ways in which this experience impacts on the transition to widowhood. Methods: Longitudinal, in-depth, semistructured interviews were conducted with older women three times over a one-year period after the death of their husbands. This report focuses on the initial interviews that examined the transition from caregiving to widowhood. Transcripts were analyzed using interpretive phenomenological analysis methods. Participants were community-dwelling women older than 65 years who had recently been caregivers for their husbands who died within the past two years. Results: Older women caregivers described their caregiver role as taxing, particularly in light of their own chronic conditions that they failed to prioritize and address. They did not ask for help in managing their roles and health problems, but quietly endured. Hence, they did not communicate their needs or strains explicitly. The degree of perceived adequacy of communication and interaction with health professionals were important factors impacting on their bereavement. Conclusion: It is imperative for health professionals to appreciate that older women caregivers may need more supportive interaction and information during the end-of-life caregiving, they may have expectations of communication, and they may deny or fail to focus on their own health issues. A patient/family/carer- centered approach could negate this oversight and improve the outcomes for these women as they transition into widowhood. 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Soh, K.L., Davidson, P.M., Leslie, G., Digiacomo, M. & Soh, K.G. 2013, 'Nurses' perceptions of standardised assessment and prevention of complications in an ICU', Journal of Clinical Nursing, vol. 22, no. 5-6, pp. 856-865.
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Aims and objectives: To describe nurses' perceptions of evidence-based recommendations to prevent complications in a Malaysian intensive care unit. Background: Ventilator-associated pneumonia, catheter-related blood stream infection and pressure ulcer are three frequent adverse events in the intensive care unit. Implementing evidenced-based practice is critical in prevention of these complications. Design: A qualitative focus group study. Methods: Focus groups were conducted with nurses in the intensive care unit of a regional hospital in Malaysia following evidence-based interventions. Focus group transcripts were analysed using the method of thematic analyses. Results: Thirty-four nurses participated in eight focus groups. The main themes derived from the interviews: (1) nurses' knowledge impacts on the change process; (2) initial resistance, ambivalence and movement to acceptance; and (3) hierarchical organisational structure can hinder the change process. Conclusion: Enhancing nurses' knowledge and attitudes of evidence-based practice, providing them with tools to monitor their clinical practice, and empowering them to change practice are likely to be important in influencing clinical outcomes. Increasing the emphasis on evidence-based practice in nursing curricula and engaging in cultural change processes in the workplace are necessary to improve clinical outcomes. Relevance to clinical practice: These findings provide valuable information for implementing clinical practice improvement interventions. 2012 Blackwell Publishing Ltd.
Deek, H., Abbott, P., Moore, L., Davison, J., Cameron, S., DiGiacomo, M., McGrath, S.J., Dharmendra, T. & Davidson, P.M. 2013, 'Pneumococcus in aboriginal and Torres Strait Islander peoples: The role of aboriginal health workers and implications for nursing practice', Contemporary Nurse, vol. 46, no. 1, pp. 54-58.
Background: Pneumonia is a common cause of hospitalization in Aboriginal and Torres Strait Islander men and women. Aim: This article seeks to describe the importance of immunizing against pneumonia in Aboriginal Australians and suggest strategies for screening and follow-up. Method: An integrative literature review, using both published and gray literature was undertaken to identify methods of screening and surveillance strategies for pneumococcus. Results: The literature was summarized under the following themes: Pneumococcal disease; prevention strategies; access to care; improving access to vaccinations; culturally competent interventions and the role of Aboriginal health professionals. Conclusion: Community controlled conditions and the role of the Aboriginal Health Workers are seen as critical to reducing health disparities. Nurses can play a critical role in bridging the gap between mainstream and community controlled organizations. Working to increase the numbers of Aboriginal health professionals is a critical step in improving health outcomes for Aboriginal and Torres Strait Islander peoples.
Digiacomo, M., Lewis, J., Nolan, M.T., Phillips, J. & Davidson, P.M. 2013, 'Health transitions in recently widowed older women: A mixed methods study', BMC Health Services Research, vol. 13, no. 1.
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Background: Older recently widowed women are faced with increased health risks and chronic conditions associated not only with bereavement, but also, older age. Loss and grief, adjusting to living alone, decreased income, and managing multiple chronic conditions can impact on older women's ability to transition following recent spousal bereavement. Providing appropriate, timely, and effective services to foster this life transition is of critical importance, yet few services directed towards these women exist in Australia, and there is little data describing the experiences of women and their support needs at this time. Methods. We conducted a longitudinal mixed method study using in-depth semi-structured interviews and questionnaires that were administered three times over a twelve month period to understand the experiences and needs of older women in the period following their husbands' deaths. Descriptive statistics and Interpretive Phenomenological Analysis were used to analyse quantitative and qualitative data, respectively, prior to data integration. Results: Participants were twenty-one community-dwelling recently widowed older women who were an average age of 71 (SD 6.13) years. The majority of participants scored within normal ranges of depression, anxiety, and stress, yet a subset of participants had elevated levels of each of these constructs (37%, 27%, and 19%, respectively) throughout the study period. Positive self-reports of general health predominated, yet 86% of participants were living with one or more chronic condition and taking an average of 4 medications per day. The majority (76%) experienced exacerbations of existing conditions or were diagnosed with a new illness in the early bereavement period, leading to planned and unplanned hospitalisations and other health service use. Qualitative data provided insight into these experiences, the meanings women ascribed to them, and their reasons for enacting certain health risk behaviours. Conclusio...
Davidson, P.M., Mitchell, J.A., DiGiacomo, M., Inglis, S.C., Newton, P.J., Harman, J. & Daly, J. 2012, 'Cardiovascular disease in women: Implications for improving health outcomes', Collegian, vol. 19, no. 1, pp. 5-13.
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Objective: To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. Design: Literature review. Results: Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction.Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven.Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications.The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors.Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women.Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina.Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. Conclusions: Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government. 2011 Royal College of Nursing, Australia.
Jiwa, M., Davidson, P.M., Newton, P.J., DiGiacomo, M., McGrath, S. & Lotriet, C. 2012, 'Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia', Journal of Cancer Therapy, vol. 3, no. 4A, pp. 1-6.
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Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two- phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualita-tive thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was con-sidered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people un-der-report morbidity related to smoking and chronic obstructive pulmonary disease; other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes.
Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2012, 'Disease management interventions for improving self-management in lower-limb peripheral arterial disease (Protocol)', The Cochrane Database of Systematic Reviews, vol. 3, pp. 1-11.
Evidence supports the use of chronic disease management interventions to improve self-management in chronic diseases other than PAD, however it is unclear what benefits these interventions offer for people with PAD. To our knowledge, there are no other systematic reviews of the evidence for chronic disease management interventions to improve self-management for lower-limb PAD. The objective of this review is to systematically review, synthesise and quantify the effects of non-pharmacological and non-surgical chronic disease management interventions targeting self-management for people with lower-limb PAD.
Davidson, P.M., Meleis, A.I., McGrath, S.J., DiGiacomo, M., Dharmendra, T., Puzantian, H.V., Song, M. & Riegel, B. 2012, 'Improving Women's Cardiovascular Health: A Position Statement From the International Council on Women's Health Issues', Health Care for Women International, vol. 33, no. 10, pp. 943-955.
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Cardiovascular disease (CVD) is the number one killer of women worldwide, and it remains the primary cause of death and disability in both developed and developing countries. The International Council on Women's Health Issues is an international nonprofit association dedicated to the goals of promoting the health, health care, and the well-being of women. Based on the outcomes of a facilitated discussion at its 18th biannual meeting, delegates aim to raise awareness about the potent influence of gender-specific factors on the development, progression, and outcomes of CVD. Key recommendations for decreasing the burden of CVD are also discussed. 2012 Copyright Taylor and Francis Group, LLC.
Cao, X., Cao, Y., Salamonson, Y., DiGiacomo, M., Chen, Y., Chang, S., Riegel, B. & Davidson, P.M. 2012, 'Translation and validation of the Chinese version of the Acute Coronary Syndrome Response Index (C-ACSRI)', International Journal of Nursing Studies, vol. 49, no. 10, pp. 1277-1290.
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Background: Patients' knowledge, attitudes, and beliefs toward acute coronary syndrome are important predictors of delay in seeking medical attention. Currently, there is no instrument in China to measure these factors. Without such an instrument, there is limited understanding of the knowledge, attitudes and beliefs of Chinese patients. The Acute Coronary Syndrome Response Index is a validated instrument to measure patients' knowledge, attitudes, and beliefs about the symptoms and responses to acute coronary syndrome. Objectives: The study aims to translate and validate a Chinese version of the Acute Coronary Syndrome Response Index and to assess the knowledge, attitudes, and beliefs of individuals in mainland China with a history of coronary heart disease. Design: Cross-sectional study. Setting: Two tertiary teaching general hospitals and community in Shandong province, Eastern China. Participants: Individuals with a history of coronary heart disease. Method: The Acute Coronary Syndrome Response Index was professionally translated and piloting was undertaken to ensure equivalence of meaning and cultural appropriateness. Two means were used for participant recruitment: (1) direct approach in hospital and (2) advertisement in a popular health magazine in Shandong province. Principal component analysis was performed to examine the construct validity, and internal consistency was assessed using Cronbach's alpha values. Results: 224 participants with coronary heart disease were recruited, including 158 in-patients and 66 individuals living in the community. Participants' mean age was 64.3 13.8 years. The majority of participants (61.7%) were male. Cronbach's coefficient for total scores of the Chinese version of Acute Coronary Syndrome Response Index was 0.81, 0.79 for knowledge, 0.87 for attitudes, and 0.71 for the beliefs scale. Pearson's method of bivariate correlation test demonstrated convergent validity. Conclusion: The Chinese version of Acute Coronary Synd...
Everett, B., DiGiacomo, M., Rolley, J.X., Salamonson, Y. & Davidson, P.M. 2011, 'You won't know if you don't ask: Discrepancy and ambivalence in attitudes toward behavior change', Journal of Cardiovascular Nursing, vol. 26, no. 6, pp. 460-465.
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Background: Behavior change is challenging following an acute cardiac event, and commonly, individuals are ambivalent. Aim: The objective of this study was to describe the experience of behavior change of survivors of an acute cardiac event. Method: Semistructured interviews were undertaken with 25 participants attending 3 cardiac rehabilitation programs. An inductive process of qualitative thematic analysis was used to analyze the transcripts. Results: Analysis revealed ambivalence to change, misconceptions, and confusion about terminology. Discrepancies between what participants felt they should be doing and what they actually were doing reflected their ambivalence. Further inconsistencies were reflected in participants' misunderstandings and confusion regarding disease processes and management of heart disease. Conclusions: These findings reflect the misconception and ambivalence regarding behavior change that individuals experience. Clinicians may require greater skills in detecting conflicting or ambivalent discourse to support patients through sustainable health behavior change. Copyright 2011 Lippincott Williams & Wilkins.
Davidson, P.M., DiGiacomo, M. & McGrath, S.J. 2011, 'The feminization of aging: How will this impact on health outcomes and services?', Health Care for Women International, vol. 32, no. 12, pp. 1031-1045.
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We conducted an integrative review to identify issues and challenges that face aging women and to distinguish areas for future research. We found that many older women continue to face inequities related to health and often are invisible within the discourse of aging policy. In this article we argue for a greater focus on the unique needs of women, a gendered approach to policy and intervention development, and promotion of the health of women across the life span. Policymakers, health care workers, and researchers need to consider the perspective of gender as well as age when implementing and evaluating effective interventions. Taylor & Francis Group, LLC.
Rolley, J., Smith, J., DiGiacomo, M., Salamonson, Y. & Davidson, P. 2011, 'The caregiving role following percutaneous coronary intervention', Journal of Clinical Nursing, vol. 20, no. 1-2, pp. 227-235.
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Aim: The aim of this study is to describe the experience of caregivers of individuals who have had a percutaneous coronary intervention (PCI). Background: Decreased lengths of hospital stay and an increased emphasis on chronic disease self-management increase the importance of carers in assisting in recovery and lifestyle modification. Design: Cross-sectional dual-moderated focus group design. Method: Three focus groups using a dual facilitation approach were held in the cardiac rehabilitation setting of a tertiary referral hospital in metropolitan Sydney. All sessions were audio recorded, transcribed and thematically analysed. Results: Four themes emerged from the data: (1) a gendered approach to health, illness and caring; (2) shock, disbelief and the process of adjustment following PCI; (3) challenges and changes of the carer-patient relationship and (4) the needs of the carer for support and information. Issues emerging from this study parallel other findings describing the experience, yet provide new insights into the issues surrounding PCI. Conclusion: These findings highlight the need for including carers in care planning and decision-making and providing them with support and resources. Relevance to clinical practice: Emphasises the importance of preparing carers of the likely experience following a PCI.Demonstrates the degree to which vigilance, deferment of carer-health needs and role conflict impact on the carer's personal relationship.Demonstrates the need for formal support interventions for carers of patients who have had PCI. 2010 Blackwell Publishing Ltd.
Gholizadeh, L., Digiacomo, M., Salamonson, Y. & Davidson, P.M. 2011, 'Stressors influencing middle eastern women's perceptions of the risk of cardiovascular disease: a focus group study', Health Care for Women International, vol. 32, no. 8, pp. 723-745.
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To better understand Australia-dwelling Middle Eastern women's lack of service utilization in cardiovascular health, we undertook a study to investigate their understandings and meanings of cardiovascular disease (CVD) and its risk factors. Eight focus groups were conducted in community settings with Turkish, Persian, and Arab women. We found that the women understated their risk of CVD, faced many barriers in reducing their risks, and perceived stress as the most significant contributor to CVD. Women described their stress as primarily emanating from issues surrounding. Taylor & Francis Group, LLC.
Davidson, P.M., Jiwa, M., Goldsmith, A.J., McGrath, S.J., Digiacomo, M., Phillips, J.L., Agar, M., Newton, P.J. & Currow, D.C. 2011, 'Decisions for lung cancer chemotherapy: The influence of physician and patient factors', Supportive Care in Cancer, vol. 19, no. 8, pp. 1261-1266.
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Purpose: The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients influence clinical communication, doctor-patient interaction and treatment decisions for lung cancer treatment. Methods: Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011. Results: Wide variability in perceptions of the value of chemotherapy in lung cancer is present among both physicians and patients. There is a mismatch in the degree patients and physicians weigh survival, such that patients value survival benefits highly whilst physicians strongly emphasize toxicity and associated symptoms. This lack of congruence between patients and clinicians is influenced by a range of factors and has implications for treatment decisions, long-term survival and quality of life in people affected by lung cancer. Conclusion: The divergence of treatment priorities indicates a need for improved communication strategies addressing the needs and concerns of both patients and clinicians. Patients should understand the benefits and risks of treatment options, while clinicians can gain a greater awareness of factors influencing patients' decisions on treatments. Reflecting these perspectives and patient preferences for lung cancer treatment in clinical guidelines may improve clinician awareness. 2011 Springer-Verlag.
Chang, S., Gholizadeh, L., Salamonson, Y., DiGiacomo, M., Betihavas, V. & Davidson, P.M. 2011, 'Health span or life span: The role of patient-reported outcomes in informing health policy', Health Policy, vol. 100, no. 1, pp. 96-104.
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Objectives: Population ageing and the increasing burden of chronic conditions challenge traditional metrics of assessing the efficacy of health care interventions and as a consequence policy and planning. Using chronic heart failure (CHF) as an exemplar this manuscript seeks to describe the importance of patient-reported outcomes to inform policy decisions. Methods: The method of an integrative review has been used to identify patient-reported outcomes (PROs) in assessing CHF outcomes. Using the Innovative Care for Chronic Conditions the case for developing a metric to incorporate PROs in policy planning, implementation and evaluation is made. Results: In spite of the increasing use of PROs in assessing CHF outcomes, their incorporation in the policy domain is limited. Conclusions: Effective policy and planning is of health care services is dependent on the impact on the individual and their families. Epidemiological transitions and evolving treatment paradigms challenge traditional metrics of morbidity and mortality underscoring the importance of assessing PROs. 2010 Elsevier Ireland Ltd.
Davidson, P.M., Daly, J., Leung, D., Ang, E., Paull, G., DiGiacomo, M., Hancock, K., Cao, Y., Du, H. & Thompson, D.R. 2011, 'Health-seeking beliefs of cardiovascular patients: A qualitative study', International Journal of Nursing Studies, vol. 48, no. 11, pp. 1367-1375.
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Objectives: The study aims were to (a) describe the experiences of Chinese Australians with heart disease following discharge from hospital for an acute cardiac event; (b) identify patterns and cultural differences of Chinese Australians following discharge from hospital; and (c) illustrate the illness/health seeking behaviors and health beliefs of Chinese Australians. Design: Qualitative study. Methods: Interview data were obtained from the following sources: (a) focus groups of Chinese community participants without heart disease; (b) interviews with patients recently discharged from hospital following an admission for an acute cardiac event; and (c) interviews with Chinese-born health professionals working in Australia. Qualitative thematic analysis was undertaken. Results: Study themes generated from the data were: (1) linking traditional values and beliefs with Western medicine; (2) reverence for health professionals and family; and (3) juxtaposing traditional beliefs and self-management. Conclusions: Considering the influence of cultural values in developing health care plans and clinical decision making is important. 2011 Elsevier Ltd.
Digiacomo, M., Davidson, P.M., Zecchin, R., Lamb, K. & Daly, J. 2011, 'Caring for others, but not themselves: implications for health care interventions in women with cardiovascular disease.', Nurs Res Pract, vol. 2011, p. 376020.
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Cardiovascular disease is the largest killer of women internationally and women often suffer inferior outcomes following an acute cardiac event as compared to men. A gendered approach to investigating cardiovascular disease in women incorporates the unique social, cultural, and economic circumstances that being a woman brings to the health encounter. The multiple roles enacted by many women may be important factors in this health discrepancy. In order to more fully understand the impact of the roles of women on health, a questionnaire was administered to participants of the Heart Awareness for Women group cardiac rehabilitation program which assessed women's role perceptions followed by discussions. We found that caregiving can be both positive and negative. It gives a sense of purpose, meaning, and community connection as well as burden and conflict. Emphasis must be placed on promoting strategies in women to achieve a balance between caregiving responsibilities and prioritisation of cardiovascular health.
Lewis, J.M., Digiacomo, M., Currow, D.C. & Davidson, P.M. 2011, 'Dying in the margins: Understanding palliative care and socioeconomic deprivation in the developed world', Journal of Pain and Symptom Management, vol. 42, no. 1, pp. 105-118.
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Context: Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. Objectives: To evaluate the literature in the developed world for barriers to access for low SE groups. Methods: Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. Results: A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. Conclusion: Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required. 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Davidson, P.M., McGrath, S.J., Meleis, A.I., Stern, P., DiGiacomo, M., Dharmendra, T., Correa-De-Araujo, R., Campbell, J.C., Hochleitner, M., Messias, D.K.H., Brown, H., Teitelman, A., Sindhu, S., Reesman, K., Richter, S., Sommers, M.S., Schaeffer, D., Stringer, M., Sampselle, C., Anderson, D., Tuazon, J.A., Cao, Y. & Covan, E.K. 2011, 'The health of women and girls determines the health and well-being of our modern world: A white paper from the international council on women's health issues', Health Care for Women International, vol. 32, no. 10, pp. 870-886.
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The International Council on Women's Health Issues (ICOWHI) is an international nonprofit association dedicated to the goal of promoting health, health care, and well-being of women and girls throughout the world through participation, empowerment, advocacy, education, and research.We are a multidisciplinary network of women's health providers, planners, and advocates from all over the globe. We constitute an international professional and lay network of those committed to improving women and girl's health and quality of life. This document provides a description of our organization mission, vision, and commitment to improving the health and well-being of women and girls globally. Taylor & Francis Group, LLC.
Davidson, P.M., DiGiacomo, M., Thompson, S.C., Abbott, P.A., Davison, J., Moore, L., Daly, J., McGrath, S., Taylor, K. & Usherwood, T. 2011, 'Health workforce issues and how these impact on Indigenous Australians', Journal of Australian Indigenous Issues, vol. 14, no. 4, pp. 69-84.
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Indigenous Australians suffer a disproportionate burden of iII health estimated to be 2.5 times higher than other Australians. A number of complex and multifaceted factors impact not only on health inequity but also imbalance in the health workforce. Addressing workforce issues for both Indigenous and non-Indigenous health workers is vital in decreasing the gap in health and social outcomes for Indigenous Australians. It is widely recognised that the capacity of the lndigenous health workforce is a crucial factor in responding effectively to Indigenous health needs. Using the typology of workforce imbalances proposed by Zurn and colleagues, this paper critically analyses issues within Australia impacting on the health workforce, arguing that it is impossible to consider workforce issues for Indigenous health without regard for global, sociodemographic, cultural, geographic and economic factors.
Sayers, J.M., DiGiacomo, M. & Davidson, P.M. 2011, 'The nurse educator role in the acute care setting in Australia: Important but poorly described', Australian Journal of Advanced Nursing, vol. 28, no. 4, pp. 44-52.
Objective The purpose of this paper is to describe the nurse educator role in the acute care setting in Australia. Method A literature review using Ganong's (1987) method of analysis was undertaken. Computerised databases were searched for articles published in English between 2000 and 2008 using the key words: 'education', 'nursing', 'nurse-educator', 'teaching methods', 'clinical', 'outcomes health care' and 'Australia'. Information was summarised to identify issues impacting on the nurse educator role using a standardised data extraction tool. Results The search strategies generated 152 articles and reports. The review identified that the nurse educator role is fundamental in supporting clinical practice and integral to developing a skilled and competent health workforce. Conclusion Confusion in nursing roles and role ambiguity contribute to the challenges for nurse educators in acute care. The absence of a national, standardised approach to role description and scope of practice in Australia may adversely impact role enactment. Further discussion and debate of the nurse educator role in Australia is warranted.
DiGiacomo, M., Davidson, P.M., Abbott, P.A., Davison, J., Moore, L. & Thompson, S.C. 2011, 'Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: Elements of effective interventions', International Journal of Environmental Research and Public Health, vol. 8, no. 2, pp. 388-410.
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Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations. 2011 by the authors; licensee MDPI, Basel, Switzerland.
Lam, S., Davidson, P.M., Leslie, G., DiGiacomo, M., Rolley, J.X., Soh, K. & Rahman, A. 2011, 'Factors to drive clinical practice improvement in a Malaysian intensive care unit: assessment of organizational readiness using a mixed method approach', International Journal of Multiple Research Approaches, vol. 5, no. NA, pp. 104-121.
This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16-bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identifi ed as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes.
DiGiacomo, M., Davidson, P.M., Abbott, P.A., Davison, J., Moore, L. & Thompson, S.C. 2011, 'Smoking cessation in indigenous populations of Australia, New Zealand, Canada, and the United States: elements of effective interventions.', Int J Environ Res Public Health, vol. 8, no. 2, pp. 388-410.
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Indigenous people throughout the world suffer a higher burden of disease than their non-indigenous counterparts contributing to disproportionate rates of disability. A significant proportion of this disability can be attributed to the adverse effects of smoking. In this paper, we aimed to identify and discuss the key elements of individual-level smoking cessation interventions in indigenous people worldwide. An integrative review of published peer-reviewed literature was conducted. Literature on smoking cessation interventions in indigenous people was identified via search of electronic databases. Documents were selected for review if they were published in a peer-reviewed journal, written in English, published from 1990-2010, and documented an individual-level intervention to assist indigenous people to quit smoking. Studies that met inclusion criteria were limited to Australia, New Zealand, Canada, and the USA, despite seeking representation from other indigenous populations. Few interventions tailored for indigenous populations were identified and the level of detail included in evaluation reports was variable. Features associated with successful interventions were integrated, flexible, community-based approaches that addressed known barriers and facilitators to quitting smoking. More tailored and targeted approaches to smoking cessation interventions for indigenous populations are required. The complexity of achieving smoking cessation is underscored as is the need to collaboratively develop interventions that are acceptable and appropriate to local populations.
Soh, K.L., Davidson, P.M., Leslie, G., DiGiacomo, M., Rolley, J.X., Soh, K.G. & Rahman, A.A. 2011, 'Factors to drive clinical practice improvement in a Malaysian intensive care unit : Assessment of organizational readiness using a mixed method approach', International Journal of Multiple Research Approaches, vol. 5, no. 1.
This study assessed organisational readiness and factors to drive clinical practice improvement for VAP, CRBSI and PU in a Malaysian intensive care unit (ICU). A mixed method study approach was undertaken in a 16 bed ICU in regional Malaysia using an environmental scan, key informant interviews, staff surveys, and patient audit to elucidate factors contributing to planning for clinical practice improvement. Measurements of sustainability of practice and regard for the practice environment were assessed using validated measures. An environmental scan demonstrated high patient occupancy and case load. Nineteen percent of ICU patients developed complications according to validated measures. Survey results indicated that the majority of nurses had a good knowledge of strategies to prevent ICU complications and a positive attitude toward change processes. Engaging executive leadership was identified as crucial in priming the clinical site for practice change. Providing nurses with tools to monitor their clinical practice and empowering them to change practices are important in improving clinical outcomes. 2008-2010 eContent Management.
Davidson, P.M., Gholizadeh, L., Haghshenas, A., Rotem, A., DiGiacomo, M., Eisenbruch, M. & Salamonson, Y. 2010, 'A review of the cultural competence view of cardiac rehabilitation', Journal of Clinical Nursing, vol. 19, no. 9-10, pp. 1335-1342.
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Aims and objectives: This paper describes cultural competence issues within the scientific and scholarly discourse surrounding cardiac rehabilitation (CR). Background: CR is an important secondary prevention strategy, improving health-related outcomes and reducing the risks of subsequent cardiovascular events. Internationally, it is widely accepted as a discrete health service model and is endorsed by government and professional bodies. Over past decades, low participation rates in CR remain a concern, particularly among minority groups and culturally and linguistically diverse populations. Design: Systematic review. Methods: Search of electronic databases. Conclusions: Few studies to date have described cultural competence in CR service design and as a consequence, there are minimal data to assist CR professionals and policy makers in tailoring health service delivery models. The limited scholarly debate and discussion regarding cultural competence in the CR literature limits the development and evaluation of culturally appropriate interventions. Relevance to clinical practice: There needs to be greater attention to the concept of cultural competence, both in practice and research settings, to ensure access to CR for people from culturally and linguistically diverse backgrounds. 2010 Blackwell Publishing Ltd.
DiGiacomo, M.L., Thompson, S.C., Smith, J.S., Taylor, K.P., Dimer, L.A., Ali, M.A., Wood, M.M., Leahy, T.G. & Davidson, P.M. 2010, ''I don't know why they don't come': Barriers to participation in cardiac rehabilitation', Australian Health Review, vol. 34, no. 4, pp. 452-457.
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Objectives. To describe health professionals' perceptions of Aboriginal people's access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Design. Qualitative study. Setting. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Participants. Thirty-eight health professionals working in the CR setting. Method. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Results. Emergent themes included (1) a lack of awareness of Aboriginal CR patients' needs; (2) needs related to cultural awareness training for health professionals; and (3) Aboriginal health staff facilitate access for Aboriginal patients. Conclusions. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes. AHHA 2010.
Digiacomo, M., Lam, P., Roberts, B.L., Lau, T.C., Song, R. & Davidson, P.M. 2010, 'Exploring the reasons for adherence to T'ai chi practice', Journal of Alternative and Complementary Medicine, vol. 16, no. 12, pp. 1245-1246.
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Digiacomo, M., Davidson, P.M., Taylor, K.P., Smith, J.S., Lyn Dimer, E.N., Ali, M., Wood, M.M., Leahy, T.G. & Thompson, S.C. 2010, 'Health information system linkage and coordination are critical for increasing access to secondary prevention in Aboriginal health: A qualitative study', Quality in Primary Care, vol. 18, no. 1, pp. 17-26.
Background Aboriginal Australians have low rates of participation in cardiac rehabilitation (CR), despite having high rates of cardiovascular disease. Barriers to CR participation reflect multiple patientrelated issues. However, an examination of the broader context of health service delivery design and implementation is needed. Aims To identify health professionals' perspectives of systems related barriers to implementation of the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples.1 Method Semi-structured interviews were conducted with health professionals involved in CR within mainstream and Aboriginal Community Controlled Health Services in Western Australia (WA). Thirty-eight health professionals from 17 services (ten rural, seven metropolitan) listed in the WA Directory of CR services and seven Aboriginal Medical Services in WA were interviewed. Results Respondents reported barriers encountered in health information management and the impact of access to CR services for Aboriginal people. Crucial issues identified by participants were: poor communication across the health care sector and between providers, inconsistent and insufficient data collection processes (particularly relating to Aboriginal ethnicity identification), and challenges resulting from multiple clinical information systems and incompatible technologies. Conclusions This study has demonstrated that inadequate information systems and communication strategies, particularly those representing the interface between primary and secondary care, contribute to the low participation rates of Aboriginal Australians in CR. Although these challenges are shared by non-Aboriginal Australians, the needs are greater for Aboriginal Australians and innovative solutions are required. 2010 Radcliffe Publishing.
Digiacomo, M., Abbott, P., Davison, J., Moore, L. & Davidson, P.M. 2010, 'Facilitating uptake of aboriginal adult health checks through community engagement and health promotion', Quality in Primary Care, vol. 18, no. 1, pp. 57-64.
Background Adult Health Checks (AHCs) for Aboriginal and Torres Strait Islander people (MBS Item 710) promote comprehensive physical and psychosocial health assessments. Despite the poor uptake of health assessments in Aboriginal and Torres Strait Islander people, a small number of successful implementation initiatives have been reported. In order to ensure uptake of these screening initiatives, there remains a need to demonstrate the feasibility of models of implementing AHCs. Aims The aim of mis paper is to address the process issues and overarching outcomes of a two-day targeted screening and assessment programme to increase the uptake of AHCs at an Aboriginal Community Controlled Medical Service. Method Clients of an urban Aboriginal Medical Service (AMS) were invited to undertake an AHC during a two-day screening initiative. On-site general practitioners (GPs), nurses, and Aboriginal Health Workers (AHWs) worked within a team to facilitate screenings at an AMS. Barriers and facilitators to the initiative and strategies for quality improve-ment were discussed by the team. A review of medical notes was undertaken six months following the screening days to document uptake of recommendations. Results Forty clients undertook AHCs as part of the initiative. In total, 113 diagnostic tests, interventions, specialist referrals and medication initiatives had been enacted within the following six months as a result of screening day visits. Benefits to individual clients, the community, the AMS and staff were identified. Conclusions The screening day demonstrated feasibility and acceptability of this approach and provides support for its implementation in other health facilities. Importantly, this service was provided in a culturally sensitive framework and within an interdisciplinary teamwork model This targeted approach increased uptake of assessment items and provided opportunities for health advice and risk factor modification. 2010 Radcliffe Publishing.
Davidson, P.M., Abbott, P., Davison, J. & DiGiacomo, M. 2010, 'Improving Medication Uptake in Aboriginal and Torres Strait Islander Peoples', Heart Lung and Circulation, vol. 19, no. 5-6, pp. 372-377.
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Background: Poor medication adherence is associated with adverse health outcomes. Improving access and adherence to pharmacological therapy is important in achieving optimal health outcomes for Indigenous populations. In spite of the impressive evidence base for cardiovascular pharmacotherapy, strategies for promoting adherence and evidence based practice are less well refined and the challenges for Indigenous populations are more pronounced. Aim: To identify factors impacting on medication adherence in Aboriginal Australians and identify solutions to improve the quality use of medicines. Method: The World Health Organization adherence model was used to classify barriers to adherence. Key elements of this model are (1) health care team/health system; (2) socio-economic factors; (3) therapy; (4) patient; and (5) condition related. Results: Entrenched socio-economic differentials aggravate challenges to medication adherence amongst Aboriginal Australians. Initiatives to promote the quality use of medicines, such as the Quality Use of Medicines Maximised for Aboriginal and Torres Strait Islander People (QUMAX) Program, are important strategies to promote adherence. Conclusions: Medication adherence is a complex issue and addressing modifiable factors is imperative to improve health outcomes. Subsidised access to medications whether living in urban, regional, rural or remote areas is an important strategy in Closing the Gap. 2010.
Sayers, J.M. & DiGiacomo, M. 2010, 'The nurse educator role in Australian hospitals: Implications for health policy', Collegian, vol. 17, no. 2, pp. 77-84.
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To date, the nurse educator role in the Australian hospital setting has been poorly described. Current pressures for health care reform have prompted reviews of nursing roles. This paper discusses the literature pertaining to the nurse educator role within the context of the Australian health care environment and current health care policy. Building on this synthesis, barriers and facilitators impacting on the nurse educator role are identified and strategic directions for policy, role clarification and advanced practice role development are highlighted. Further research identifying the impact of the hospital-based nurse educator on patient outcomes and professional nursing practice are proposed. 2010.
Cao, Y., Davidson, P.M., Digiacomo, M. & Yang, M. 2010, 'Prehospital delay for acute coronary syndrome in China', Journal of Cardiovascular Nursing, vol. 25, no. 6, pp. 487-496.
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Background: Despite the effectiveness of timely reperfusion therapy for acute coronary syndrome, prehospital delay remains a global concern. Objective: This article assesses the state-of-the-science regarding prehospital delay for acute coronary syndrome in China. Method: Electronic databases and hand searching were undertaken using key words such as prehospital delay, care-seeking delay, coronary heart disease, heart disease, acute coronary syndrome, unstable angina pain, acute myocardial infarction, cardiovascular disease, chest pain, and Chin (China/Chinese). The Chinese search was supervised by a Chinese health librarian. Results: Based on the search criteria, 28 studies were identified and reviewed using a standardized data extraction tool. Older age, attribution of symptoms to noncardiac causes, lack of health insurance coverage, poor access to transportation, and female sex were identified as contributing to prehospital delay. Conclusion: Health system reforms in China are necessary, particularly with regard to addressing the needs of older people, women, and other vulnerable populations in the context of the rising number of people with coronary heart disease. Developing targeted strategies, learned from both national and international experience, are required to develop targeted interventions. Copyright 2010 Wolters Kluwer Health. Lippincott Williams & Wilkins.
Thompson, S.C., DiGiacomo, M.L., Smith, J.S., Taylor, K.P., Dimer, L., Ali, M., Wood, M.M., Leahy, T.G. & Davidson, P.M. 2009, 'Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: An assessment of CR Services across Western Australia', Australia and New Zealand Health Policy, vol. 6, no. 1.
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Background: Cardiovascular disease is the major cause of premature death of Indigenous Australians, and despite evidence that cardiac rehabilitation (CR) and secondary prevention can reduce recurrent disease and deaths, CR uptake is suboptimal. The National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples, published in 2005, provide checklists for services to assist them to reduce the service gap for Indigenous people. This study describes health professionals' awareness, implementation, and perspectives of barriers to implementation of these guidelines based on semi-structured interviews conducted between November 2007 and June 2008 with health professionals involved in CR within mainstream health services in Western Australia (WA). Twenty-four health professionals from 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services were interviewed.Results: The majority of respondents reported that they were unfamiliar with the NHMRC guidelines and as a consequence implementation of the recommendations was minimal and inconsistently applied. Respondents reported that they provided few in-patient CR-related services to Indigenous patients, services upon discharge were erratic, and they had few Indigenous-specific resources for patients. Issues relating to workforce, cultural competence, and service linkages emerged as having most impact on design and delivery of CR services for Indigenous people in WA.Conclusions: This study has demonstrated limited awareness and poor implementation in WA of the recommendations of the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples: A Guide for Health Professionals. The disproportionate burden of CVD morbidity and mortality among Indigenous Australians mandates urgent attention to this problem and alternative approaches to CR d...
Gholizadeh, L., Salamonson, Y., Worrall-Carter, L., Digiacomo, M. & Davidson, P.M. 2009, 'Awareness and causal attributions of risk factors for heart disease among immigrant women living in Australia', Journal of Women's Health, vol. 18, no. 9, pp. 1385-1393.
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Objective: Coronary heart disease (CHD) is a major cause of morbidity and mortality globally, and risk factors for CHD are associated with social and cultural attribution as well as individual psychological factors. The aims of this study were to explore the causal attributions of risk factors for CHD and to describe the relationship between their physiological status and causal attributions among immigrant Arabic, Turkish, and Iranian women living in Australia. Methods: Fifty-five women of Turkish, Iranian, and Persian backgrounds were recruited from community groups in metropolitan Sydney using snowball sampling and the assistance of bilingual health care workers. Body weight and blood pressure were assessed, and a questionnaire, including investigator-developed instruments and the Depression, Anxiety and Stress Scale, was administered. Health interpreters assisted with study procedures and translation of study instruments. Results: There was a low level of awareness of the risk of heart disease among women, although participants had knowledge of risk factors for heart disease broadly. The most highly attributed risk factors for CHD among participants were obesity, physical inactivity, and psychological distress. Women who rated highly on psychological distress scores were more likely to attribute negative emotions as causative factors for heart disease. Conclusions: Strategies to promote the awareness of the association between heart disease and women are required among migrant women. Further investigation is required to overcome the barriers to engaging in effective risk minimizing behaviors for heart disease. 2009 Mary Ann Liebert, Inc.
Cao, Y., Davidson, P.M. & DiGiacomo, M. 2009, 'Cardiovascular disease in China: An urgent need to enhance the nursing role to improve health outcomes', Journal of Clinical Nursing, vol. 18, no. 5, pp. 687-693.
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Aims. This paper reviews the role of cardiac nursing in China and the potential of this professional group to take an important role in secondary and tertiary prevention initiatives. Background. China is undergoing unprecedented economic growth, yet globalisation of Chinese society has caused an increase in the prevalence of chronic conditions, particularly cardiovascular disease. Studies recognise that health providers and members of the public are not fully aware of the risks associated with cardiovascular disease and consequently are not equipped to deal with this looming epidemic. Design. Position paper. Method. This position paper summarises and discusses the burden of cardiovascular disease in China within the context of evidence for nurse-coordinated interventions. Barriers and facilitators to developing the nursing role in contemporary China are discussed. Conclusions. A key strategy for promoting the role of nurse-led programmes in China is increasing research skills among Chinese nurses to promote independent, collaborative interdisciplinary research. Promoting doctoral education in China, increasing the status of nursing in interdisciplinary teams, collaborating with cardiovascular nurses internationally and increasing the public's awareness of cardiovascular disease are critical steps in promoting nurse-led programmes to improve the health and well-being of the community. Relevance to clinical practice. Given the positive relationship between knowledge and skill levels of nurses and clinical outcomes, China's investment in the education and training of its nursing workforce is critical in improving practice and outcomes in cardiovascular disease. 2009 Blackwell Publishing Ltd.
DiGiacomo, M., Rolley, J., Smith, J. & Davidson, P.M. 2009, 'Shock, disbelief, and the process of adjusting and coping: women's experience of caring for their spouses following a percutaneous coronary intervention', JOURNAL OF WOMENS HEALTH, vol. 18, no. 5, pp. 749-749.
Cao, Y., Digiacomo, M., Du, H.Y. & Davidson, P.M. 2009, 'Chinese nurses' perceptions of heart health issues facing women in China: a focus group study.', The Journal of cardiovascular nursing, vol. 24, no. 6.
BACKGROUND: China is in a state of rapid economic growth and epidemiological transition. Morbidity and mortality relating to heart disease in women have increased dramatically. OBJECTIVES: The aim of this study was to obtain the views of nurses regarding heart health issues for women in contemporary China. DESIGN:: This study used focus group interviews. SETTINGS: Convenience sampling was used to recruit nurses working in acute care hospitals in metropolitan China. METHODS: Five focus groups containing 28 female participants were conducted. Focus groups were moderated by 2 bilingual Chinese nurses, audiotaped, and analyzed using thematic analysis. RESULTS: Four themes emerged from the focus group data: (1) mixed perceptions of disease burden in women, (2) modern life impacts upon women's health, (3) need for focus on prevention and coordination, and (4) education and support are keys to driving healthcare improvements. CONCLUSIONS: Heart disease, as a significant health issue for women in China, is underappreciated among Chinese nurses.
Davidson, P.M., Cao, Y., Digiacomo, M. & Du, H.Y. 2009, 'Chinese nurses' perceptions of heart health issues facing women in China: A focus group study', Journal of Cardiovascular Nursing, vol. 24, no. 6.
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BACKGROUND:: China is in a state of rapid economic growth and epidemiological transition. Morbidity and mortality relating to heart disease in women have increased dramatically. OBJECTIVES:: The aim of this study was to obtain the views of nurses regarding heart health issues for women in contemporary China. DESIGN:: This study used focus group interviews. SETTINGS:: Convenience sampling was used to recruit nurses working in acute care hospitals in metropolitan China. METHODS:: Five focus groups containing 28 female participants were conducted. Focus groups were moderated by 2 bilingual Chinese nurses, audiotaped, and analyzed using thematic analysis. RESULTS:: Four themes emerged from the focus group data: (1) mixed perceptions of disease burden in women, (2) modern life impacts upon women's health, (3) need for focus on prevention and coordination, and (4) education and support are keys to driving healthcare improvements. CONCLUSIONS:: Heart disease, as a significant health issue for women in China, is underappreciated among Chinese nurses. 2009 Lippincott Williams & Wilkins.
Davidson, P., Digiacomo, M., Zecchin, R., Clarke, M., Paul, G., Lamb, K., Hancock, K., Chang, E. & Daly, J. 2008, 'A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease', Journal of Women's Health, vol. 17, no. 1, pp. 123-134.
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Background and aims: Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs. Methods: The Heart Awareness for Women program (HAFW) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts. The program was then trialed in an 8-week program in a convenience sample of 6 women. Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program. A total of 54 women participated in this phase, 48 of whom completed baseline questionnaires. A mixed-method evaluation, using questionnaires, interviews, and observation, assessed the impact of the intervention on psychological and social aspects of women's recovery following an acute coronary event. Results: Women welcomed the opportunity to discuss their individual stories, fears, and challenges and to derive support from contact with other women. Via health professional facilitation, women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health. No statistically significant changes in depression, anxiety, stress, cardiac control, role integration, or perceived social support were found; however, descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support. Conclusions: On the basis of this study, a cardiac rehabilitation program tailored to the needs of women appears to be feasible and acceptable. The efficacy of this intervention to improve health-related outcomes needs to be tested i...
Phillips, J.L., Davidson, P.M., Newton, P.J. & DiGiacomo, M. 2008, 'Supporting Patients and Their Caregivers After-Hours at the End of Life: The Role of Telephone Support', Journal of Pain and Symptom Management, vol. 36, no. 1, pp. 11-21.
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Twenty-four hour access is accepted as a gold standard for palliative care service delivery, yet minimal data exist to justify the cost of this initiative to health care planners and policy makers. Further, there is scant information concerning optimal and efficient methods for delivering after-hours palliative care advice and support, particularly in regional and rural settings. This article reports on an evaluation of a local after-hours telephone support service in regional Australia. A centralized after-hours telephone support service was provided by generalist nurses at a Multipurpose Service in a rural community. A mixed-method evaluation, including semistructured interviews, was undertaken after 20 months of operation. During the period March 31, 2005 until November 15, 2006, 357 patients were registered as part of the Mid North Coast Rural Palliative Care Program. Ten percent of patients or their caregivers accessed the After-Hours Telephone Support Service, representing 55 occasions of service. The most common reason for contacting the service was for reassurance surrounding medication usage, symptom management, and anxiety. This experience demonstrates proof of concept that acceptable palliative care advice can be provided by generalist nurses in a cost-efficient manner. Common patterns emerged in utilization that can assist in service planning and staffing formulae. There is also a need to investigate mechanisms of interfacing with larger scale call centers, to explore the differences within generic and disease-specific approaches, and assess the appropriateness of after-hours telephone support with different cultural groups. 2008 U.S. Cancer Pain Relief Committee.
Everett, B., Davidson, P.M., Sheerin, N., Salamonson, Y. & DiGiacomo, M. 2008, 'Pragmatic insights into a nurse-delivered motivational interviewing intervention in the outpatient cardiac rehabilitation setting', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 1, pp. 61-64.
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PURPOSE: Despite an increasing interest in motivational interviewing as a strategy to facilitate behavior change in people with cardiovascular disease, its use in cardiac rehabilitation (CR) appears minimal. Therefore, it is unclear whether the clinical method of motivational interviewing requires modification for the CR population, in which it could be argued that people are motivated and engaged. The purposes of this report are to describe processes in incorporating motivational interviewing in the CR setting and to discuss insights gained regarding the use of this intervention. METHODS: As part of a randomized controlled trial currently recruiting in the CR setting, patients allocated to the intervention group participate in 2 motivational interviewing sessions with a motivational interviewing-trained nurse. To ascertain treatment fidelity, this process review comprised 3 sources: (1) the extant literature on motivational interviewing, (2) reflections of the project team, and (3) data derived from audiotaped interviews. RESULTS: Key observations reflect that the motivational interviewing technique is well received, with patients appreciating the opportunity to "tell their story." Preliminary qualitative data revealed that patients rate "health" and "family" as their most important values, with many commenting on their recovery phase as a "second chance." CONCLUSIONS: This report demonstrates that motivational interviewing is potentially useful and has significant promise in the CR setting. Discussion of pragmatic considerations as well as outcome data should assist clinicians in implementing this model of intervention in the CR setting. 2008 Lippincott Williams & Wilkins, Inc.
DiGiacomo, M., Davidson, P.M., Davison, J., Moore, L. & Abbott, P. 2008, 'Butting out at AMSWS', Australian Nursing Journal, vol. 15, no. 10, pp. 35-35.
he high rate (50%) of smoking among Aboriginal people (ABS 2005) coupled with limited culturally appropriate smoking cessation interventions makes addressing this important public health issue a challenge. The Aboriginal Medical Service of Western Sydney (AMSWS) offers a high intensity smoking cessation program which provides support, counselling, and subsidised nicotine replacement therapy to its clients through theleadership and community advocacy of Aboriginal Health Workers. The Butt Busters program arose from significant community consultation in 2005 and has now screened over 120 clients, several of whom have quit smoking and many others who are making positive steps toward this behavioural change.
Davidson, P.M., DiGiacomo, M., Abbott, P., Zecchin, R., Heal, P.E., Mieni, L., Sheerin, N., Smith, J., Mark, A., Bradbery, B. & Davison, J. 2008, 'A partnership model in the development and implementation of a collaborative, cardiovascular education program for Aboriginal Health Workers', Australian Health Review, vol. 32, no. 1, pp. 139-146.
A partnership model was established among key education providers, policy makers, non-government organisations, the local area health service and Aboriginal community controlled organisations aimed at increasing collaboration, skill development, cultural competence and increasing access to mentorship and expertise for Aboriginal Health Workers (AHWs). A group of 21 AHWs, within two cohorts, undertook the program between October 2005 and June 2006. A mixed-method evaluation using quantitative and qualitative data collection methods was undertaken prospectively. Knowledge and confidence scores significantly increased for all participants over the course duration. Student evaluation demonstrated a desire for group-based activities and the high value placed on clinical visits. Feedback on both outcome and process measures will inform course delivery and design.
Davidson, P.M., DiGiacomo, M., Zecchin, R., Clarke, M., Paul, G., Lamb, K., Hancock, K., Chang, E. & Daly, J. 2008, 'A cardiac rehabilitation program to improve psychosocial outcomes of women with heart disease', Journal of Women's Health, vol. 17, no. 1, pp. 123-134.
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Background and aims: Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs. Methods: The Heart Awareness for Women program (HAFW) commenced in 2003 with phase I involving development of program elements and seeking validation through consumers and clinical experts. The program was then trialed in an 8-week program in a convenience sample of 6 women. Phase II applied the revised program using action research principles focusing on enabling clinical staff to implement the ongoing program. A total of 54 women participated in this phase, 48 of whom completed baseline questionnaires. A mixed-method evaluation, using questionnaires, interviews, and observation, assessed the impact of the intervention on psychological and social aspects of womens recovery following an acute coronary event. Results: Women welcomed the opportunity to discuss their individual stories, fears, and challenges and to derive support from contact with other women. Via health professional facilitation, women were able to develop strategies collectively to address risk factor modification and achieve optimal cardiovascular health. No statistically significant changes in depression, anxiety, stress, cardiac control, role integration, or perceived social support were found; however, descriptive and qualitative findings revealed decreases in anxiety and an increased sense of social support.
Davidson, P.M., Salamonson, Y., Webster, J., Andrew, S., DiGiacomo, M., Gholizadeh, L., Newton, P. & Moser, D. 2008, 'Changes in depression in the immediate postdischarge phase in a cardiac rehabilitation population assessed by the cardiac depression scale', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 5, pp. 312-315.
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? INTRODUCTION: Depression is increasingly a focus of attention in the management of heart disease. Clinicians in cardiac rehabilitation (CR) are well placed to assess and facilitate management of symptoms of depression, yet the timing and interpretation of measurements remain unclear. ? METHODS: We administered the Hare-Davis Cardiac Depression Scale (CDS) in a usual care, outpatient CR program in a metropolitan setting. As part of routine assessment and monitoring of outcomes in a 6-week outpatient CR program, we administered the CDS at entry, at completion of the 6-week program, and at 12 months. ? RESULTS: Data were available on 151 patients for the 3 measurement points. At baseline, the mean CDS score was 76.07 (22.38), which dropped at 6 weeks to 64.85 (21.69) but increased slightly at 12 months to 69.79 (24.36). The changes in these scores were statistically significant for all measurement points (P < .03). The trend of change for the CDS was reflected in the subscale scores, which dropped at 6 weeks but increased slightly at 12 months. ? DISCUSSION: Findings demonstrate a positive impact of CR on CDS scores at 6 weeks and 12 months, although there was a trend for increased scores at 1 year. This observation requires further investigation and underscores the importance of longitudinal studies. 2008 Lippincott Williams & Wilkins, Inc.
Cao, Y., Digiacomo, M., Du, H.Y., Ollerton, E. & Davidson, P. 2008, 'Cardiovascular disease in chinese women: An emerging high-risk population and implications for nursing practice', Journal of Cardiovascular Nursing, vol. 23, no. 5, pp. 386-394.
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Globally, cardiovascular disease (CVD) is the leading cause of death among women. In China, the burden of CVD is increasing at an alarming rate; yet, it is underestimated and has important primary, secondary, and tertiary prevention issues. AIM:: This article seeks to document the issues surrounding the increased rate of CVD among Chinese women and describe the etiological factors and potential strategies to decrease the burden of disease. METHODS:: The Medline, Current Information in Nursing and Allied Health Literature, Ovid, Science Direct, and Government Reports were searched using the key words heart disease, cardiovascular, ischemic heart disease, coronary, women, and Chin (China, Chinese). Articles were selected if they described epidemiological factors and/or interventions to address heart disease in Chinese women. FINDINGS:: Rapid industrialization and urbanization in China have extended the life expectancy of the population, particularly among women. Social, political, and economic factors have caused lifestyle changes that have a direct bearing on health. Heart disease has become the most common cause of death among Chinese women and the second most common cause among men. Paradoxically, prevention and management strategies are sparse in relation to the high prevalence. A number of modifiable risk factors have been identified as major contributors of CVD and should be a focus of primary, secondary, and tertiary prevention. CONCLUSION:: Cardiovascular disease is already a leading cause of death and disability among Chinese women. The high prevalence of risk factors and low rate of awareness, treatment, and control signal an urgent need for focusing on this issue in Chinese women. Strategies on individual, community, and government levels are recommended. Involving Chinese nurses in these strategies is essential. 2008 Lippincott Williams & Wilkins.
Parry, A., Worrall-Carter, L., Page, K., Kuhn, L., DiGiacomo, M. & Davidson, P.M. 2007, 'Returning to work: Exploring the experiences of women with acute coronary syndromes', British Journal of Cardiac Nursing, vol. 2, no. 6, pp. 292-301.
Aims: The aim of this study was to explore the transition experiences of Australian women in resuming paid employment after an acute coronary syndrome (ACS) event. Background: Until recently cardiovascular research has focused predominantly on men but this is changing and research exploring womens experiences of ACS has increased. Despite knowing that many women do not resume paid employment following an ACS event, little is known about the experience of those women who do, even though it is understood that returning to the previous level of employment after an ACS event is a positive outcome. Design: An exploratory qualitative approach underpinned by naturalistic inquiry was undertaken. Methods: A purposive sample of seven women who had experienced their first ACS event 12 months ago was selected. Each woman was interviewed using a semistructured format and their interviews were transcribed verbatim. Thematic analysis of the transcript set and conceptual mapping were employed to formulate key themes. Findings: All women (mean age 52.6 years) resumed paid employment at various stages during their recovery, but reported similar transition processes. Three key themes representing this process were identified: primary motivation; influence through guidance and support; and resuming paid employment. Conclusions: Study findings revealed that these women required substantial support from family, friends and employers, with ongoing guidance from health professionals to return to paid work. The timeframes for their return varied and some modified their roles within the workforce to enable them to return to paid work. However, formal cardiac rehabilitation did not appear to have a significant impact on these participants decisions to return to work. They felt that more information about this decision may have been helpful if given at the time of cardiac rehabilitation.
Davidson, P.M. & Digiacomo, M. 2007, 'Illness perceptions influence involvement in rehabilitation programs and adoption of lifestyle changes following acute myocardial infarction: Commentary', Australian Occupational Therapy Journal, vol. 54, no. 4, pp. 318-319.
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Halcomb, E.J., Gholizadeh, L., DiGiacomo, M., Phillips, J. & Davidson, P.M. 2007, 'Literature review: Considerations in undertaking focus group research with culturally and linguistically diverse groups', Journal of Clinical Nursing, vol. 16, no. 6, pp. 1000-1011.
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Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background. The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. Methods. The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms 'focus group', 'cultural sensitivity', 'transcultural nursing', 'transcultural care', 'cultural diversity' and 'ethnic groups'. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. Results. Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. Conclusions. Focus groups are a useful tool to expand existing knowledge about service provision an...
DiGiacomo, M., Davidson, P.M., Vanderpluym, A., Snell, R. & Worrall-Carter, L. 2007, 'Depression, anxiety and stress in women following acute coronary syndrome: Implications for secondary prevention', Australian Critical Care, vol. 20, no. 2, pp. 69-76.
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Objective: To document incidence of depression, anxiety, and stress in women more than 6 months following an acute coronary syndrome. Design: Participants were identified from a coronary care unit database. The Depression Anxiety Stress Scales 21 (DASS 21) was sent to potential participants via postal survey. Setting: A metropolitan teaching hospital in Melbourne, Australia. Participants: The cohort of women was aged between 55 and 70 years. They had been admitted to hospital with a diagnosis of acute coronary syndrome (ACS) between 6 and 14 months prior to participating in this study. Main outcome measures: Scores on Depression, Anxiety, and Stress Scale (DASS 21). Results: Of the 117 posted questionnaires, 39 women with a mean age of 63 (S.D. 4.97) responded to the survey, representing a response rate of 33.3%. Most participants scored within normal levels of depression (66.7%), anxiety (60.5%), and stress (70.3%), however, mild to extremely severe levels of each construct (33.4%, 39.6%, and 29.7%, respectively) were found. Conclusions: The reporting of elevated levels of depression, anxiety and stress in a subset of women more than 6 months following an ACS event underscores the importance of ongoing screening for risk factors impacting on psychological well-being and the inclusion of this information in education and counseling strategies in both the inpatient and outpatient settings. Based on these pilot data, consideration of a screening system in the immediate post discharge period for women at risk and an education or support service are recommended. 2007 Australian College of Critical Care Nurses Ltd.
DiGiacomo, M., Davidson, P.M., Davison, J., Moore, L. & Abbott, P. 2007, 'Stressful life events, resources, and access: Key considerations in quitting smoking at an Aboriginal Medical Service', Australian and New Zealand Journal of Public Health, vol. 31, no. 2, pp. 174-176.
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Objective: Aboriginal and Torres Strait Islander people experience adverse health outcomes and have high rates of smoking and related illnesses. This brief report describes stress as a barrier to quitting smoking derived from reflections within an Aboriginal Medical Service and makes recommendations for intervention development. Methods: A high-intensity smoking cessation program was conducted within a suburban Aboriginal Medical Service in Western Sydney, Australia, over a 10-month period. The intervention included weekly cessation counselling sessions and dispensation of free nicotine replacement therapy (NRT). Results: During the observation period, 32 clients made quit attempts. To date, three clients (9%) have quit smoking. Chronic and intercurrent life stressors were noted to be the main barriers to smoking cessation described by participants. Conclusions: Achieving smoking cessation among Indigenous people is made significantly more complex because of multiple life stressors experienced. Implications: Future interventions targeting Indigenous Australians should take greater account of stressful life events and their impact on quitting smoking. 2007 The Authors. Journal Compilation 2007 Public Health Association of Australia.
Davison, J., Moore, L., DiGiacomo, M. & Davidson, P.M. 2006, 'Partnerships improve cardiovascular health', Australian Nurses Journal, vol. 14, no. 2, pp. 31-31.
Cardiovascular disease (CVD) is the leading cause of death in the AiLstralian Indigenous population (ABS and AIHW 2001). Unfortunately, Australian Aboriginals have not benefited from the reductions in CVD seen in other sectors of the population
Davidson, P.M. & DiGiacomo, M. 2006, 'Improving cardiovascular health: a collaborative education program for AHWs', Australian Nurses Journal, vol. 14, no. 2, pp. 26-26.
The high rate of cardiovascular morbidity and mortality among Indigenous Australians is of k ^ concern and demands novel aiid innovative strategies (Brown et al 2005). Aboriguial Healtli Workers (AHW) play a vital role in accessing communities in order to address cardiovascular risk factor modification
DiGiacomo, M., Adamson, B. & Mahony, M.J. 2004, 'Limitations in conducting cross-cultural research: Organisational behaviour examined', INTERNATIONAL JOURNAL OF PSYCHOLOGY, vol. 39, no. 5-6, pp. 441-441.
DiGiacomo, M. & Adamson, B. 2001, 'Coping with stress in the workplace: Implications for new health professionals', Journal of Allied Health, vol. 30, no. 2, pp. 106-111.
Because health care professionals must provide high-quality care while simultaneously adjusting to the new demands of a rapidly changing health care system, work stress and possibly even burnout are prevalent issues for both senior professionals and recent health science graduates upon entry into the workforce. This article examines the experience of stress and the importance of coping abilities, particularly focusing on students enrolled in health professional courses and those who have recently entered the workforce. It also presents research pertaining to whether newly graduated health professionals are coping effectively with the demands of work. Suggestions for improving stress-copingabilities are given.

Non traditional outputs

DiGiacomo, M. & Davidson, P.M. 2013, 'Australian women outlive men then struggle with disadvantage', The Conversation, The Conversation Media Trust, Melbourne.
This article refers to the recent Council of Australian Government (COAG) Reform Council's report, Tracking equity: Comparing outcomes for women and girls across Australia, which charts Australias gender disparities over a lifetime. It contains discussion of older women's experiences of ageing in Australia, where some find themselves isolated, poor, and ill-equipped to meet the challenges of living alone with multiple chronic conditions. It The article highlights the need for innovative strategies to identify women at higher risk of poor outcomes and the imperative to deliver cross-sector strategies.
Ferguson, C., DiGiacomo, M. & Davidson, P.M. 2012, 'Ladykiller: the hidden danger to women's health', The Conversation, The Conversation.
Cardiovascular disease is the biggest killer of women in Australia. It accounts for more than 40% of all female deaths, which means it kills more Australian women than breast cancer and lung cancer combined. But few women are aware of their risk and many wouldnt necessarily be able to recognise warning signs. Part of the difficulty stems from the fact that heart disease is often not obvious and, sometimes, it has no symptoms. High blood pressure (hypertension), for instance, is a major risk factor in cardiovascular disease and can easily go undetected for years. So many women remain unaware that heart disease and stroke are major health issues for them.
  • Aboriginal Medical Service Western Sydney
  • University of Western Sydney
  • Johns Hopkins University