Ben Harris-Roxas’s research while affiliated with University of Technology Sydney and other places

Background This qualitative study investigated experiences and understandings of health literacy for those released from prison in later life. The global rise in older incarcerated individuals—defined as those aged 50 and above—poses significant public health and health equity challenges. With up to one in four prisoners being categorized as "older," their complex health needs often exceed those of younger inmates and the general community. An important but under-investigated challenge for this older population is navigating health care systems and self-management of health after release. Research evidence, albeit limited, has consistently identified health literacy deficits in this this population, complicating their health outcomes and reintegration more generally. This study fills a gap in the experience of health literacy for older people leaving prison, thus contributing to conceptual understandings and guiding targeted intervention development for this marginalised population. Results Fifteen people with lived experience of release from prison in older age (mean age = 57) and thirteen staff or stakeholders with relevant professional experience from Australia participated in workshops and interviews exploring health literacy during the post-release period. An abductive thematic analysis was applied to the data, guided by the concept of health literacy and organisational health literacy responsiveness. The analysis produced two global themes (“Change” and “Equipped and Enabled”) and seven subthemes (“A demanding time of change”, “Braving a new world”, “Leaving prison care”, “I can only do what I can”, “Help me help myself”, “Others are key”, “Everybody’s problem, nobody’s job”). Together, these themes indicated these individuals are the subject of complex and overlapping life circumstances, with limited resources and support currently available for health literacy both during and after release. Conclusion This population are mostly passive health care and information ‘receivers’ as a result of their imprisonment, who must be equipped and enabled to become more active health literacy ‘doers’. This can be achieved through interventions that prepare the person better for life in community, and improve positive self-concept. Health and custodial organisations have an important role to play, with opportunities for improvement apparent across areas such as communication, focused health literacy policies, and collaboration with community partners.

Aim Public health campaigns, including Australian cancer screening programs, are increasingly promoted online through government websites. The accessibility of these initiatives for people with intellectual disability is unknown. However, a lack of accessible information about available services is an important barrier to cancer screening for this group. This study aimed to investigate the accessibility of online information for cancer screening programs. Subject and methods Australian government health websites promoting the national breast, bowel, and cervical screening programs were identified and web pages were evaluated for their compliance with Web Content Accessibility Guidelines 2.0, cognitive accessibility guidelines, readability recommendations, and where relevant, compliance with Easy Read guidelines. Results The most common accessibility errors included low-contrast colors, missing alternative text, broken links, and excessive content. Readability was a consistent issue, with most materials written at levels considered too high for both people with intellectual disability and the general population. The limited number of documents that were readily available in Easy Read did not follow guidelines. Conclusion These findings demonstrate that government public health initiatives currently fail to meet the communication and information needs of people with intellectual disability. This places the population at risk of continued under-screening and fails to uphold their right to information about their healthcare. The creation and dissemination of accessible materials should be a priority for governments and health services.

Aims People with intellectual disability experience stark health inequalities, often because of poor access to mainstream healthcare. This scoping review aimed to identify factors that influence access to healthcare for people with intellectual disability using Levesque and colleagues’ comprehensive framework of healthcare access. Method This review followed Joanna Briggs Institute guidelines. Articles were identified and retrieved from CINAHL, PsycINFO, PubMed and EMBASE. Two reviewers completed abstract and full-text screening, addressing any conflicts at each stage. Data was extracted and coded deductively, according to the supply (healthcare provider) and demand (healthcare seeker) dimensions of Levesque and colleagues’ framework. Results Following search and screening, 66 references were included for review. Barriers to healthcare were more frequently identified in the literature compared to facilitators, with most information relating to supply-side dimensions. Barriers were related to inaccessible health information, low health literacy, stigma and discrimination by healthcare providers, and lack of organisational support, training and resourcing in both healthcare and support sectors. Facilitators often involved specialist workforces, strong interpersonal skills among healthcare providers, and advocacy from supporters. Importantly, findings indicated that both sociohistorical processes and support networks are necessary to understanding access experiences for people with intellectual disability. Conclusions Greater efforts are required internationally to ensure the health rights of people with intellectual disability, to eliminate discrimination, and provide the support and resources necessary for all stakeholders to facilitate healthcare access. Models of healthcare access for people with intellectual disability should consider both the role of supporters and the sociohistorical context within which healthcare access occurs.

Background: Public-private partnerships (PPPs) in the health sector are established to achieve health outcomes by maximising the combined resources of both public and private sectors. Good governance is core to PPP function and success. This paper explores the factors that enable and constrain governance in the delivery of PPPs for primary health care in low-and lower-middleincome countries (LMICs). Methods: A systematic search of four literature databases was conducted to identify peer reviewed articles published between 2000 and 2023 related to the governance of PPPs for primary health care in LMICs. A deductive analysis of data extracted from selected articles against the domains of Greer’s TAPIC governance framework was conducted to identify commonly reported enabling and constraining factors. Results: Of the 4,290 records screened, 14 were included. Common enabling factors for governance within each domain of the framework were found: Transparency: unequal and topdown resource allocation, and opaque and resource allocation was a barrier to PPP governance; Accountability and policy Capacity: monitoring and evaluation; Participation: partner engagement, covering topics of developing and managing relationships, collaborative activities, and communication; and Integrity: the design of the PPP, covering formal agreements between partners, level of policy direction, and integration within the broader health system. Conclusion: The five domains of the TAPIC governance framework provide guidance for considering governance in PPPs. The enabling factors identified in the review help facilitate the successful implementation of a PPP and thus influence the PPP’s impact on health outcomes, through establishing and maintaining healthy working relationships between partners, and defining and documenting systems and processes.

Background Caregiving is an essential yet often overlooked component of health care. Although carers play a pivotal role in reducing healthcare costs and improving patient outcomes, they are also prone to psychological and physical burdens that can lead to their own hospitalisation. This study aimed to explore the relationship between the frequency of interactions with general practitioners and hospitalisation rates among caregivers aged ≥45 years in New South Wales, Australia. Methods This cohort study retrospectively identified participants from the Sax Institute’s 45 and Up Study in New South Wales, linked with national datasets. The cohort comprised 26,004 individuals aged ≥45 years who were caregivers. The primary outcome was hospitalisation within a 7-year period, and the intervention was whether the patient was a high or low general practice (GP) user, ascertained by determining if the average number of annual GP visits was above or below 11, respectively. Data analysis included descriptive statistics and Poisson regression models. Results The study found a statistically significant association between high GP use and reduced rates of hospitalisation among caregivers. Caregivers with frequent GP interactions had a relative risk of hospitalisation of 0.514 (95% CI: 0.479–0.550) compared with their counterparts who infrequently used GP services. This association remained significant, even after adjusting for various demographic and health-related factors with an adjusted relative risk of 0.619 (95% CI: 0.554–0.690). Conclusions The findings underscore the potential of primary care interventions in reducing hospitalisations among caregivers, in turn providing economic and societal benefits. They also highlight the need for future research to understand the specific aspects of GP interactions that contribute to this protective effect.

Introduction/Objectives Individually rare, rare diseases are collectively common resulting in frequent health system use. Navigating the health system persists as a challenge. Primary care provides longitudinal contact with the health system and is placed to provide integrated rare-disease-care. Methods This scoping review used Joanna Briggs Institute and PRISMA methods with a Consolidated Framework for Implementation Research based data extraction tool to find how integrated rare-disease-care is delivered, enablers and barriers to the same, in primary care settings in contemporary literature in OECD countries. Results The Primary Care Provider (PCP) role varies from routine primary care to shared-rare-disease-care models. In the 26 papers, the most frequently cited PCP roles included involvement in diagnosis (n = 14), care coordination (n = 16), primary and preventative care (n = 18), management of components of rare-disease-care (n = 13), and treatment monitoring (n = 10). Individuals whose PCP was actively involved in their care were reported to have shortened diagnostic delay, improved transitions of care across the lifespan, reduced unplanned utilization of emergency and hospital services, comprehensive psychosocial care, improved quality of life across environments including home, school and work and improved palliative care experiences. Conclusions Sufficient communication from specialists, information, resources, time and reimbursement for complex care are still needed. Future integrated-rare-disease-care models should be developed by, or with, PCPs.

Background Growing numbers of avoidable low-acuity visits to emergency departments (ED) are a major health policy concern globally and are thought to contribute to ED crowding. This study explores the differences in the utilisation of low-acuity ED visits between culturally and linguistically diverse (CaLD) migrants and English-speaking background (ESB) population. Methods A study based on a cross-sectional survey of individuals aged 45 or over linked to routinely collected ED visit records in New South Wales. We employed a negative binomial regression model to compare the number of yearly low-acuity ED visits between individuals from ESB and CaLD backgrounds after adjusting for relevant health-related and sociodemographic characteristics. Results We analysed 227 681 individuals with a mean age of 61, two-thirds of whom came from an ESB. Among individuals with a CaLD background, only those born in Australia had comparable rates of low-acuity ED visits as those with an ESB. In contrast, individuals with CaLD backgrounds who were born overseas were significantly less likely to make low-acuity visits to the ED compared with those from an ESB irrespective of year of arrival—for those who had migrated less than 20 years ago (relative risk (RR) 0.72, 95% CI 0.62 to 0.83) and those who migrated more than 20 years ago (RR 0.91, 95% CI 0.88 to 0.95). Conclusion Foreign-born migrants aged 45 and over from CaLD backgrounds tend to have the lowest rates of low-acuity ED visits, particularly those who migrated more recently indicating low-acuity visits by CaLD patients are unlikely to contribute to ED crowding.

https://www.education.unsw.edu.au/news-events/news/reflective-practices-answer-generative-ai

Background This qualitative study investigated experiences and understandings of health literacy for those released from prison in later life. The global rise in older incarcerated individuals—defined as those aged 50 and above—poses significant public health and health equity challenges. With up to one in four prisoners being categorized as "older," their complex health needs often exceed those of younger inmates and the general community. An important but under-investigated challenge for this older population is navigating health care systems and self-management after release. Research evidence, albeit limited, has consistently identified health literacy deficits in this this population, complicating their health outcomes and reintegration more generally. This study fills a gap in the experience of health literacy for older people leaving prison, thus contributing to conceptual understandings and guiding targeted intervention development for this marginalised population. Results Fifteen people with lived experience of release from prison in older age (mean age = ) and thirteen staff or stakeholders with relevant professional experience from Australia participated in workshops and interviews exploring health literacy during the post-release period. An abductive thematic analysis was applied to the data, guided by the concept of health literacy and organisational health literacy responsiveness. The analysis produced two global themes (“Change” and “Equipped and Enabled”) and seven subthemes (“A demanding time of change”, “Braving a new world”, “Leaving prison care”, “I can only do what I can”, “Help me help myself”, “Others are key”, “Everybody’s problem, nobody’s job”). Together, these themes indicated these individuals are the subject of complex and overlapping life circumstances, with limited resources and support currently available for health literacy both during and after release. Conclusion This population are mostly passive health care and information ‘receivers’ as a result of their imprisonment, who must be equipped and enabled to become more active health literacy ‘doers’. This can be achieved through interventions that prepare the person better for life in community, and improve positive self-concept. Health and custodial organisations have an important role to play, with opportunities for improvement apparent across areas such as communication, focused health literacy policies, and collaboration with community partners.