General Practice and Primary Care - Theses

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    The design and implementation of a health and lifestyle screening app to improve the care of young people in general practice
    Webb, Marianne Julie ( 2018)
    Adolescence and young adulthood are periods of major transition in physical, cognitive, social, and emotional development along the journey from childhood to adulthood. However, despite experiencing a high prevalence and co-occurrence of mental health disorders and lifestyle issues, young people do not usually seek professional help for these concerns. Yet, young people do regularly attend general practice, usually to address physiological concerns, making General Practitioners (GPs) ideally situated to opportunistically discuss a range of health and lifestyle issues and to provide health promotion and early intervention as needed. Technology-based screening provides an acceptable and systematic format for identifying health issues before the consultation. However, this screening technology is not being utilised by GPs. The aim of my research was to investigate the design, implementation, and effectiveness of a preventive screening technology intervention for supporting conversations about young people’s health and lifestyle risks in general practice. To address this aim I conducted three studies using a mixed methods multiphase design. The first study was a systematic review of the literature, which provided an understanding of the need and rationale for developing a health and lifestyle technology-based screening tool in primary care. The second study was a series of co-design workshops with 16 young people, 8 GPs, and 8 parents of young people, and interviews conducted with 11 practice support staff, to identify and explore user and stakeholder design and implementation requirements of a technologybased screening tool. The final study was an effectiveness-implementation study in one general practice clinic in Melbourne, Australia. For the effectiveness component of the final study, I compared the exit surveys of 30 young people in a one-month pre-intervention, treatment-as-usual phase with 85 young people using a health and lifestyle screening app in a two-month intervention phase, when the app was integrated into young people’s routine care. I also conducted semi-structured interviews with 14 young people from the intervention group. The implementation component of the final study was an in-depth implementation case study, with methodology informed by action research. Semi-structured interviews and focus groups were conducted with four GPs and seven support staff at the end of the implementation period. In addition, I analysed the number of times staff were supported by researchers, the location where young people completed the app, whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of making their appointment. I present the findings of my studies in this thesis in four published peer reviewed articles. The results indicated that integrating a health and lifestyle screening app into face-to-face regular care of young people improved patient-centred care, and created scope to identify and address unmet health needs. However, the implementation of the app in the dynamic and time-poor general practice setting presented a range of technical and administrative challenges. My research shows that an effective way to engage young people in their health and wellbeing may be to resource preventive screening implementation into routine general practice care. My research also provides evidence that to drive and support sustainable technology innovation and implementation in general practice settings more resources, external to existing practice staff, are needed.
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    We understand our gender best: gender diverse young people and their experiences with general practitioners
    Paulson, Madeleine ( 2017)
    Gender diverse young people are a marginalised population with specific health care needs. Studies suggest that these needs are not being met by their general practitioners (GPs), but existing research focuses on gender diverse adults or non-Australian populations. The experiences of Australian gender diverse young people with GPs have not been studied in depth. Thirty-seven young gender diverse people shared their experiences with GPs. Many had negative experiences with GPs, with a majority of non-binary people having had mostly negative experiences. Participants’ experiences were positively impacted by GPs showing respect for gender diverse people, GPs being knowledgeable about gender diversity, a positive and friendly attitude from GPs, a welcoming clinic environment in which gender diverse patients were called by their chosen names, and GPs treating gender diverse patients like autonomous individuals. Negative experiences were characterised by GPs being uninformed or misinformed about gender diversity, GPs being insulting or demeaning, clinics requiring that patients be known by their birth names and assigned genders, GPs and staff misgendering gender diverse patients, and GPs attributing gender diversity to mental illness or vice versa. This study was conducted through an online survey, asking open-ended questions which provided answers suitable for qualitative analysis. Answers were analysed through thematic analysis, using a framework based on that of phenomenology. The recommendations put forth are that GPs must be educated on gender diversity; paperwork and computer systems should be able to accept input of genders other than male and female; GPs should respect gender diverse patients as individuals who know themselves; clinic waiting rooms should be welcoming and staff educated about gender diversity; GPs should not assume that gender diversity causes or is caused by mental illness; and GPs should believe, listen to, and respect the input of gender diverse patients. Further study on this topic could focus on the experiences of gender diverse Indigenous people, people born outside of Australia, or people living in regional areas; or on the experience of gender diverse people with other healthcare practitioners.
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    Sexting and young people: a qualitative study
    Walker, Shelley Joy ( 2012)
    This study is one of the first Australian studies to describe the phenomenon of sexting from the perspective of young people. ‘Sexting’, which involves the production and distribution of sexually explicit images via information and communication technologies (ICTs) has led to young people being excluded from friendship groups, moving schools, suffering anxiety and depression, and in extreme cases being charged with the production and distribution of child pornography. There is an absence of published studies undertaken in this area, particularly from an Australian perspective and from the point of view of young people themselves. My study addresses this gap by exploring the meaning of sexting in young people’s lives. It focuses in particular on the nature of sexting, the reasons why young people are involved in the behaviour and potential solutions for addressing harmful consequences. A qualitative methodology involving two phases was used. The first phase involved a focus group and individual interviews with twelve key informant professionals to develop a context that would inform the second phase, which involved individual semi-structured interviews with 33 young people aged 15-20 years (female [n=18]; male [n=15]). Young people were sourced via youth health, recreational and educational settings using purposive snowball sampling. Results were thematically analysed using a grounded theory approach. Key informant findings helped frame interviews with young people, and affirmed that young people’s voices needed to be heard. Many of the views of key informants were also reflected in the views of young people. Findings exposed a number of themes, including in particular, the gendered nature of the behavior. Of particular concern is that young women feel pressured by young men, who feel pressured by each other to be involved in the behaviour; young people observed that our sexualised media culture places pressure on young women and men to conform to gendered stereotypes that influence the behavior of sexting. Conversations with young people highlighted complexities of the phenomenon not revealed previously, including that definitions used in prevalence studies need to represent changes in young people’s use of ICTs. Young people’s views on solutions highlight that education about the implications of sexting is not the only answer, especially given young people’s views on the origins of sexting and what is known about young people and risk taking from a developmental perspective. Both young women and men were concerned about the potential harmful outcomes for those involved in the behavior, with recognition that young people should be involved in the design of solutions. Findings present important implications for future prevention approaches.