Muhsin Michael Orsini, David L. Wyrick, William B. Hansen, Rita G. O’Sullivan, Denise Hallfors, Allan B. Steckler and Ty A. Ridenour
Alcohol, tobacco, marijuana and other drugs use typically increases in prevalence and frequency during middle and late adolescence. School health instruction often focusses on…
Abstract
Purpose
Alcohol, tobacco, marijuana and other drugs use typically increases in prevalence and frequency during middle and late adolescence. School health instruction often focusses on providing facts and rarely provides tools for addressing the psychosocial risk factors needed to prevent substance use. The purpose of this paper is to report about the effectiveness of a prevention programme delivered in US high school health classes. The intervention augments typical instruction by providing teachers with activities that can be infused in their daily teaching.
Design/methodology/approach
In total, 26 schools were randomly assigned to receive the intervention or serve as controls. Pupils were pretested near the beginning of the school year, posttest near the end of the school year and administered a final test near the beginning of the following school year. Teachers in treatment schools were provided with activities designed to target psychosocial variables known to mediate substance use onset and self-initiated cessation. These include normative beliefs, intentionality, lifestyle incongruence, beliefs about consequences of use, peer pressure resistance skills, decision-making skills, goal setting skills and stress management skills.
Findings
Hierarchical modelling analytic strategies revealed the intervention to have definable positive impacts on alcohol and cigarette use. Moreover, the intervention had strongest effects on alcohol and cigarette use among pupils who were identified at pretest as being lower-than-average risk.
Originality/value
This research provides support for providing teachers with a strategy for preventing alcohol, tobacco and other drugs that can be used in a flexible manner to augment the instruction they are already mandated to provide.
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Keywords
Christine Jorm, Rick Iedema, Donella Piper, Nicholas Goodwin and Andrew Searles
The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.
Abstract
Purpose
The purpose of this paper is to argue for an improved conceptualisation of health service research, using Stengers' (2018) metaphor of “slow science” as a critical yardstick.
Design/methodology/approach
The paper is structured in three parts. It first reviews the field of health services research and the approaches that dominate it. It then considers the healthcare research approaches whose principles and methodologies are more aligned with “slow science” before presenting a description of a “slow science” project in which the authors are currently engaged.
Findings
Current approaches to health service research struggle to offer adequate resources for resolving frontline complexity, principally because they set more store by knowledge generalisation, disciplinary continuity and integrity and the consolidation of expertise, than by engaging with frontline complexity on its terms, negotiating issues with frontline staff and patients on their terms and framing findings and solutions in ways that key in to the in situ dynamics and complexities that define health service delivery.
Originality/value
There is a need to engage in a paradigm shift that engages health services as co-researchers, prioritising practical change and local involvement over knowledge production. Economics is a research field where the products are of natural appeal to powerful health service managers. A “slow science” approach adopted by the embedded Economist Program with its emphasis on pre-implementation, knowledge mobilisation and parallel site capacity development sets out how research can be flexibly produced to improve health services.
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Lisa Wood, Nicholas J.R. Wood, Shannen Vallesi, Amanda Stafford, Andrew Davies and Craig Cumming
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting…
Abstract
Purpose
Homelessness is a colossal issue, precipitated by a wide array of social determinants, and mirrored in substantial health disparities and a revolving hospital door. Connecting people to safe and secure housing needs to be part of the health system response. The paper aims to discuss these issues.
Design/methodology/approach
This mixed-methods paper presents emerging findings from the collaboration between an inner city hospital, a specialist homeless medicine GP service and Western Australia’s inaugural Housing First collective impact project (50 Lives 50 Homes) in Perth. This paper draws on data from hospitals, homelessness community services and general practice.
Findings
This collaboration has facilitated hospital identification and referral of vulnerable rough sleepers to the Housing First project, and connected those housed to a GP and after hours nursing support. For a cohort (n=44) housed now for at least 12 months, significant reductions in hospital use and associated costs were observed.
Research limitations/implications
While the observed reductions in hospital use in the year following housing are based on a small cohort, this data and the case studies presented demonstrate the power of care coordinated across hospital and community in this complex cohort.
Practical implications
This model of collaboration between a hospital and a Housing First project can not only improve discharge outcomes and re-admission in the shorter term, but can also contribute to ending homelessness which is itself, a social determinant of poor health.
Originality/value
Coordinated care between hospitals and programmes to house people who are homeless can significantly reduce hospital use and healthcare costs, and provides hospitals with the opportunity to contribute to more systemic solutions to ending homelessness.