Implementation is a crucial component for the success of interventions in health service systems, as failure to implement well can have detrimental impacts on the effectiveness of evidence-based practices. Therefore, evaluations conducted in real-world contexts should consider how interventions are implemented and sustained. However, the complexity of healthcare environments poses considerable challenges to the evaluation of interventions and the impact of implementation efforts on the effectiveness of evidence-based practices. In consequence, implementation and intervention effectiveness are often assessed separately in health services research, which prevents the direct investigation of the relationships of implementation components and effectiveness of the intervention. This article describes multilevel decision juncture models based on advances in implementation research and causal inference to study implementation in health service systems. The multilevel decision juncture model is a theory-driven systems approach that integrates structural causal models with frameworks for implementation. This integration enables investigation of interventions and their implementation within a single model that considers the causal links between levels of the system. Using a hypothetical youth mental health intervention inspired by published studies from the health service research and implementation literature, we demonstrate that such theory-based systems models enable investigations of the causal pathways between the implementation outcomes as well as their links to patient outcomes. Results from Monte Carlo simulations also highlight the benefits of structural causal models for covariate selection as consistent estimation requires only the inclusion of a minimal set of covariates. Such models are applicable to real-world context using different study designs, including longitudinal analyses which facilitates the investigation of sustainment of interventions.

Although many Indigenous peoples demonstrate resilience and strength despite the ongoing impact colonization has on their peoples, evidence suggests poor experiences and expectations of health care professionals and access to health care. Health care professionals play an essential role in responding to family violence (FV), yet there is a paucity of evidence detailing Indigenous people's experiences and expectations of health care professionals in the context of FV. Using a meta-synthesis of qualitative studies, this article aims to address the following research question: What are Indigenous people's experiences and expectations of health care professionals when experiencing FV? The inclusion criteria comprised a qualitative study design, Indigenous voices, and a focus on expectations and experiences of health care professionals when FV is experienced. Reviewers independently screened article abstracts, and the findings from included papers were subject to a thematic analysis. Six studies were included in the final meta-synthesis representing studies from Australia, the Americas, and New Zealand. Three themes were identified. Health care professionals need to center the Indigenous person in the care they provide and demonstrate cultural awareness of how history and culture influence an individual's care requirements. Health care professionals also need to ensure they are connecting for trust with the Indigenous person, by slowly developing a rapport, yarning, and investing in the relationship. Finally, Indigenous peoples want their health care professional to work on strengthening safety from culturally inappropriate care, institutional control, and potential lack of confidentiality associated with tight-knit communities.

INTRODUCTION: Intimate partner violence detrimentally affects the social and emotional well-being of children and mothers. These two populations are impacted both individually and within the context of their relationship with one another. Child mental health, maternal mental health and the mother-child relationship may be impaired as a consequence. Early intervention to prevent or arrest impaired mother-child attachment and child development is needed. Dyadic or relational mental health interventions that include mothers with their children, such as child-parent psychotherapy, are effective in improving the mental health of both children and mothers and also strengthening their relationship. While child-parent psychotherapy has been trialled overseas in several populations, Australian research on relational interventions for children and women recovering from violence is limited. This study aims to assess the acceptability and feasibility of implementing child-parent psychotherapy in Australian families. METHODS AND ANALYSIS: Using a mixed methods, prepost design this feasibility study will examine the acceptability of the intervention to women with preschool aged children (3-5 years, n=15 dyads) and providers, and identify process issues including recruitment, retention and barriers to implementation and sustainability. In addition, intervention efficacy will be assessed using maternal and child health outcomes and functioning, and mother-child attachment measures. Young children's mental health needs are underserviced in Australia. More research is needed to fully understand parenting in the context of intimate partner violence and what works to help women and children recover. If the intervention is found to be feasible, findings will inform future trials and expansion of child-parent psychotherapy in Australia. ETHICS AND DISSEMINATION: Ethics approval obtained from clinical sites and the La Trobe University Human Research Ethics Committee (ID: HEC17-108). Results will be disseminated through conference proceedings and academic publications.

OBJECTIVES: The purpose of this study is to examine the existing literature of the major social risk factors which are associated with diabetes, hypertension and the comorbid conditions of depression and anxiety in India. DESIGN: Scoping review. DATA SOURCES: Scopus, Embase, CINAHL Plus, PsycINFO, Web of Science and MEDLINE were searched for through September 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Studies reporting data on social risk factors for diabetes or hypertension and depression or anxiety in community-based samples of adults from India, published in English in the 10 years to 2019, were included. Studies that did not disaggregate pooled data from other countries were excluded. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted study aims; methods; sample size and description; demographic, social and behavioural risk factors and a summary of findings from each paper. Risk factors were synthesised into six emergent themes. RESULTS: Ten studies were considered eligible and included in this review. Nine presented cross-sectional data and one was a qualitative case study. Six themes emerged, that is, demographic factors, economic aspects, social networks, life events, health barriers and health risk behaviours. CONCLUSIONS: Literature relating to the major social risk factors associated with diabetes, hypertension and comorbid depression and anxiety in India is sparse. More research is required to better understand the interactions of social context and social risk factors with non-communicable diseases and comorbid mental health problems so as to better inform management of these in the Indian subcontinent.

BACKGROUND: High rates of psychological-distress, trauma and social complexity are reported among young pregnant women. At the Royal Women's Hospital, Australia, young pregnant women acknowledge wanting tools to improve maternal wellbeing yet remain challenging to engage in antenatal education and support. While yoga is a widely accepted and participated activity in pregnancy, with demonstrated benefits for adult pregnant women, adolescent women are often excluded from both these yoga interventions and related pregnancy studies. METHODS: This mixed methods study examined the acceptability and benefits of yoga for young women. We recruited 30 participants aged under 24 years, who were offered twice a week, one-hour voluntary prenatal yoga sessions throughout their pregnancy. A medical file audit gathered baseline demographics, pre and post yoga session surveys were administered and brief individual interview were conducted with study participants. RESULTS: While 26 study participants were positive about the availability of a yoga program, only 15 could attend yoga sessions (mean = 8 sessions, range 1-27). No differences were found in the demographic or psychosocial factors between those who did and did not attend the yoga sessions. The medical file audit found that 60% of all the study participants had a documented history of psychological distress. Barriers to participation were pragmatic, not attitudinal, based on the timing of the group sessions, transport availability and their own health. All study participants identified perceived benefits, and the yoga participants identified these as improved relaxation and reduction of psychological distress; labour preparation; bonding with their baby in utero; and social connectedness with the yoga group peers. CONCLUSIONS: This study demonstrated yoga was acceptable to young pregnant women. For those who did participate in the sessions, yoga was found to decrease self-reported distress and increase perceived skills to assist with their labour and the birth of their baby. The provision of accessible yoga programs for pregnant young women is recommended.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality in India. Social and behavioural factors are strongly interrelated in the prevention and control of CVD. The ability to make lifestyle changes to control hypertension and diabetes (major risk factors for CVD) is determined by factors such as education, gender, caste, poverty, and urbanicity. This study aimed to improve our understanding of the inter-relationship of social and behavioural factors in the management of elevated serum glucose and high blood pressure and co-morbid mental health conditions. METHODS: A population-based catchment area cross sectional survey was conducted in Kerala, India. Data were collected from residents aged over 30 years (n = 997) using standardized tools and clinical measures. We performed latent class analysis incrementally to extract homogeneous latent classes of individuals based on their responses to social and behavioural risk factors in the survey. Using structural equation models, we assessed the mediating effect of depression and anxiety, and social or behavioural risk factors, on management of high blood pressure and raised serum glucose levels. RESULTS: The prevalence of high blood pressure and blood glucose in the sample was 33 and 26% respectively. Latent class analysis found three clusters of risk factors. One had a predominance of behavioural characteristics, another of social risk factors and the third was a low risk group. Age, female sex, and marital status had an effect on high blood pressure and high glucose, though were mediated by mental health, social and behavioural risk factors. CONCLUSIONS: Interventions to improve the management of risk factors for CVD need to address social risk factors and be sensitive to the needs of population sub-groups that may require additional support to access health services. An integration of social and health services may be required to achieve this.

The Routledge Handbook of Social Work Practice Research is the first international handbook to focus on practice research for social work.

Objectives There are growing concerns that social isolation presents risks to older people's health and well‐being. Thus, the objective of the review was to explore how technology is currently being utilised to combat social isolation and increase social participation, hence improving social outcomes for older people. Methods A systematic review of the literature was conducted across the social science and human‐computer interaction databases. Results A total of 36 papers met the inclusion criteria and were analysed using a four‐step process. Findings were threefold, suggesting that: (i) technologies principally utilised social network services and touch‐screen technologies; (ii) social outcomes are often ill‐defined or not defined at all; and (iii) methodologies used to evaluate interventions were often limited and small‐scale. Conclusion Results suggest a need for studies that examine new and innovative forms of technology, evaluated with rigorous methodologies, and drawing on clear definitions about how these technologies address social isolation/participation.

Health practitioners play an important role in identifying and responding to domestic violence and abuse (DVA). Despite a large amount of evidence about barriers and facilitators influencing health practitioners' care of survivors of DVA, evidence about their readiness to address DVA has not been synthesised. This article reports a meta-synthesis of qualitative studies exploring the research question: What do health practitioners perceive enhances their readiness to address domestic violence and abuse? Multiple data bases were searched in June 2018. Inclusion criteria included: qualitative design; population of health practitioners in clinical settings; and a focus on intimate partner violence. Two reviewers independently screened articles and findings from included papers were synthesised according to the method of thematic synthesis. Forty-seven articles were included in the final sample, spanning 41 individual studies, four systematic reviews and two theses between the years of 1992 and 2018; mostly from high income countries. Five themes were identified as enhancing readiness of health practitioners to address DVA: Having a commitment; Adopting an advocacy approach; Trusting the relationship; Collaborating with a team; and Being supported by the health system. We then propose a health practitioners' readiness framework called the CATCH Model (Commitment, Advocacy, Trust, Collaboration, Health system support). Applying this model to health practitioners' different readiness for change (using Stage of Change framework) allows us to tailor facilitating strategies in the health setting to enable greater readiness to deal with intimate partner abuse.

OBJECTIVE: To investigate whether domestic violence (DV) impacts on health professionals' clinical care of DV survivor patients. DESIGN, SETTING: Descriptive, cross-sectional study at an Australian tertiary maternity hospital. PARTICIPANTS: 471 participating female health professionals (45.0% response rate). OUTCOME MEASURES: Using logistic and linear regression, we examined whether health professionals' exposure to lifetime DV was associated with their clinical care on specific measures of training, attitudes, identification and intervention. RESULTS: DV survivor health professionals report greater preparedness to intervene with survivor patients in a way that is consistent with ideal clinical care. This indicates that personal DV experience is not a barrier, and may be a facilitator, to clinical care of survivor patients. CONCLUSIONS: Health professionals are at the front line of identifying and responding to patients who have experienced DV. These findings provide evidence that survivor health professionals may be a strength to the healthcare organisations in which they work since among the participants in this study, they appear to be doing more of the work seen as better clinical care of survivor patients. We discuss the need for greater workplace supports aimed at promoting safety and recovery from violence and strengthening clinical practice with patients.

The second of two special issues on kinship care.

The first of two special issues on kinship care.