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Background Arts‐based methodologies and methods (ABM) can elicit rich and meaningful data with seldom‐heard groups and empower participants in research. Young people with complex psychosocial needs could be better engaged in research using arts‐based approaches to overcome communication and literacy issues as well as distrust of those with power, including researchers. A critical review of the use and impact of ABM among this population is timely. The purpose of this review is to synthesize and examine the experience and use of ABM with young people with complex psychosocial needs. Methods A systematic narrative literature review was conducted with a search of the literature from 2009 to 2021. All s were reviewed independently by two authors and full papers were screened for eligibility against inclusion and exclusion criteria. Data synthesis focused on a descriptive numerical summary and a thematic analysis focused on key patterns across papers relating to the review objectives. Results and Discussion A total of 25 papers were included. The most common issues of focus were mental health (n = 10) and homelessness (n = 11) and methods using Photovoice (n = 12) and Body Mapping (n = 5). Individual interview data (n = 20) were the most commonly analysed, followed by created works (n = 19). Less than half the studies involved young people in the interpretation of the data collected. Knowledge translation was not described in almost half the studies, with public exhibits (n = 7) and forums with service providers (n = 4) being the most common activities. Key themes across the studies were valued over traditional methods in eliciting data, ABM as an approach to engage these young people in research and the impact of the use of ABM on participants and on key stakeholders through knowledge translation. Conclusions The growing field of ABM presents opportunities to enhance research with young people with complex psychosocial needs by promoting meaningful exploration of experiences, engaging participants in research and strengthening knowledge translation. The involvement of young people in the interpretation of data and ensuring that knowledge translation occurs are key areas for future attention. Patient or Public Contribution The findings of this review will inform future research to improve the engagement of young people with complex psychosocial needs in research and promote power sharing between researchers and research participants.

Background Children with medical complexity (CMC) comprise 1% of the paediatric population, but account for over 30% of health service costs. Lack of healthcare integration and coordination for CMC is well-documented. To address this, a deep understanding of local contextual factors, experiences, and family-identified needs is crucial. The aim of this research was to investigate the lived experiences of CMC, their families, and healthcare staff, focusing on understanding the dynamics of care coordination and the challenges faced in providing integrated care, in order to inform the development of effective, family-centred models of care. Methods In April to July 2022, 31 semi-structured interviews were conducted with parents/guardians of CMC and healthcare professionals who care for CMC. Interviews explored complex paediatric care and care coordination barriers. An inductive thematic analysis was undertaken. Themes were then further explored using Frank’s narrative approach. Results Through analysis, we identified that the restitution typology was absent from both staff and parent/guardian narratives. However, we uncovered narratives reflective of the chaos and quest typologies, depicting overwhelming challenges in managing complex medical needs, and proactive efforts to overcome barriers. Importantly, a novel typology termed ‘equilibrium’ was uncovered. Narratives aligning with this typology described medical complexity as a balance of power and a negotiation of roles. Within the equilibrium typology, illness trajectory was described as a series of negotiations or balancing acts between healthcare stakeholders, before finally reaching equilibrium. Participants described seeking a balance, where their expertise is respected, whilst maintaining the ability to rely on professional guidance and support. These insights provide a nuanced understanding of the multifaceted narratives shaping care experiences for CMC and their families. Conclusions Our research delineates multifaceted challenges within the care landscape for CMC, their families, and healthcare staff. Embracing the equilibrium narrative typology highlights the criticality of tailored, integrated care models. This necessitates prioritising clear role delineation and communication among caregivers, implementing support systems addressing the challenges of continuous caregiving, and integrating parents/guardians as essential members of the care team. These insights advocate for pragmatic and sustainable strategies to address the unique needs of CMC and their families within healthcare systems.

Introduction To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted. Methods This study involved the methodology of POSH‐VRE, which combines positive organisational scholarship in healthcare (POSH) with video‐reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co‐researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video‐recordings of community‐based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted. Results Brilliant community‐based palliative care nursing largely involved maintaining normality in patients’ and carers’ lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative ‘normals’. Conclusion Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community‐based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality. Patient or Public Contribution Patients and carers contributed to this study as participants, while nurses contributed to this study as co‐researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article.

One in every two cases of caries in deciduous teeth occurs in low- and middle-income countries (LMICs). The aim of the World Health Organisation's (WHO) Healthy Schools Program is to improve the oral health of children. This study explored perceptions of implementation of the Ugandan oral health schools' program in Gulu district, northern Uganda. Semi-structured interviews were conducted with a purposive sample of 19 participants including health and education officials, community leaders, policy makers, teachers, and parents. All interviews were transcribed verbatim and analysed thematically. Our study identified three themes: (1) components of oral health promotion, (2) implementation challenges of oral health promotion, and (3) development of an oral health policy. The components of oral health promotion in schools included engagement of health workers, the community, companies, skills-based education, and oral health services. Participants were concerned about insufficient funding, unsatisfactory skills-based education, and inadequate dental screening. Participants reported that there was an urgent need to develop oral health policy to guide implementation of the program at scale. Schools provided oral health promotion that aligned with existing features of the WHO's health-promoting school framework. Implementation of this strategy could be enhanced with increased resources, adequate oral health education, and explicit development of oral health policy.

The Strengthening Care for Children (SC4C) is a general practitioner (GP)-paediatrician integrated model of care that consists of co-consulting sessions and case discussions in the general practice setting, with email and telephone support provided by paediatricians to GPs during weekdays. This model was implemented in 21 general practices in Australia (11 Victoria and 10 New South Wales). Our study aimed to identify the factors moderating the implementation of SC4C from the perspectives of GPs, general practice personnel, paediatricians and families. We conducted a qualitative study as part of the mixed-methods implementation evaluation of the SC4C trial. We collected data through virtual and in-person focus groups at the general practices and phone, virtual and in-person interviews. Data was analysed using an iterative hybrid inductive-deductive thematic analysis. Twenty-one focus groups and thirty-seven interviews were conducted. Overall, participants found SC4C acceptable and suitable for general practices, with GPs willing to learn and expand their paediatric care role. GPs cited improved confidence and knowledge due to the model. Paediatricians reported an enhanced understanding of the general practice context and the strain under which GPs work. GPs and paediatricians reported that this model allowed them to build trust-based relationships with a common goal of improving care for children. Additionally, they felt some aspects, including the lack of remuneration and the work and effort required to deliver the model, need to be considered for the long-term success of the model. Families expressed their satisfaction with the shared knowledge and quality of care jointly delivered by GPs and paediatricians and highlighted that this model of care provides easy access to specialty services without out-of-pocket costs. Future research should focus on finding strategies to ensure the long-term Implementation of this model of care with a particular focus on the individual stressors in general practices.

This paper draws together critical learnings from diverse qualitative health research projects in Australia that sought to shift power and focus on the strengths and expertise of people with lived experience who are involved as co-researchers. These projects have included exploring and challenging identities, understanding experiences in treatment programs, critiquing and designing/re-designing services, and sharing experiences with the wider community in novel and innovative ways. Lived experiences included alcohol and other drug dependency, mental health, domestic, family or sexual violence, and living with HIV. This paper provides important learnings and actions about partnering with co-researchers with lived experience. In this paper we draw on a process of reflective discussions that occurred over six months with fortnightly online meetings between co-researchers, including co-authors with lived experience external to academia and university-based researchers, some of whom also have lived-experience that intersects with their research. From this, we distilled key learnings across seven themes: (1) the ethics of ethics, which highlights a need for constant reflection on the ethical issues in co-research; (2) recruiting co-researchers, which focuses on ensuring and integrating a diversity of voices; (3) creating safety for all, which must be a priority of engagement and support self-determination; (4) supporting different ways of partnering, which emphasises the need for diverse roles and ways to contribute on research teams; (5) capacity building and training, which requires ongoing evaluation of needs and tailored responses; (6) positioning, which highlights the need to transition from the idea of vulnerability to a strengths-based perspective of lived experience; and (7) power plays, reflecting the need to disrupt the dynamics and established hierarchies of privileging certain forms of knowledge and expertise. The paper includes recommendations for action against these seven themes.

General practitioners (GPs) play a pivotal role in a patient's health care journey. However, demands on general practice, including complex patient management, workforce shortages, and health system fragmentation, have been shown to adversely impact the delivery of high-quality care and health outcomes. Integrated care models, particularly those that offer virtual care options, can support improved access to quality care and efficiency of health care delivery across metropolitan and rural areas. The SUSTAIN model of care was created to provide an accessible option for integrated care. It consists of centralized pediatricians supporting GPs in their practice through virtual coconsultations, virtual \"lunch and learn\" case discussions, and phone or email support. There is limited evaluation literature on integrated models of care being implemented in a primary care setting where the GP and family are face to face and the non-GP specialist is virtual. To address this gap, a comprehensive implementation evaluation of the SUSTAIN model of care was conducted. This study aimed to examine what, why, and how different factors impact the uptake of the SUSTAIN model of care from the perspectives of the SUSTAIN pediatricians and metropolitan and rural GPs in New South Wales, Australia. A qualitative study was conducted as part of a mixed methods implementation evaluation of the SUSTAIN model of care. Data were collected via recorded online focus groups and interviews with GPs, practice managers, and pediatricians at 6 and 12 months after the commencement of SUSTAIN. Data were analyzed thematically using iterative thematic analysis informed by the Consolidated Framework of Implementation Research. Eighteen focus groups and 13 interviews were conducted. GPs, practice managers, and pediatricians found the SUSTAIN model acceptable, with the flexibility and practicality of the model highlighted. GPs valued the learning opportunities, collaboration, and support they gained from working alongside the pediatricians. Virtual delivery through telehealth was viewed as a positive means of receiving specialist support that would otherwise be inaccessible to many practices. Increased efficiency in workflow and working at the top of scope in pediatric care as well as opportunities for meaningful professional relationships and increased family trust in GP-delivered care were recognized as key benefits that enhanced uptake. The current landscape of Australian general practice, with fee-for-service billing and workflow pressures, was recognized as a barrier to engagement with SUSTAIN. GPs and pediatricians highlighted that more appropriate remuneration to support co-consultation is vital to the sustainability and scalability of the SUSTAIN model. The SUSTAIN model of care expands on our understanding of the benefits of integrated GP-pediatrician models of care in general practice by demonstrating the utility of a pediatrician supporting a GP in their practice via telehealth across metropolitan and rural environments in New South Wales, Australia.

Purpose Despite the importance of evidence-based practice, the translation of knowledge into quality healthcare continues to be stymied by an array of micro, meso and macro factors. The purpose of this paper is to suggest a need to consider different – if not unconventional approaches – like the role of positive emotion, and how it might be used to promote and sustain knowledge translation (KT). Design/methodology/approach By reviewing and coalescing two distinct theories – the broaden-and-build theory of positive emotions and the organisational knowledge creation theory – this paper presents a case for the role of positive emotion in KT. Findings Theories pertaining to positive emotion and organisational knowledge creation have much to offer KT in healthcare. Three conceptual “entry points” might be particularly helpful to integrate the two domains – namely, understanding the relationship between knowledge and positive emotions; positive emotions related to Nonaka’s concept of knowledge creation; and the mutual enrichment contained in the parallel “upward spiralling” of both theories. Research limitations/implications This is a conceptual paper and as such is limited in its applicability and scope. Future work should empirically explore these conceptual findings, delving into positive emotion and KT. Originality/value This is the first paper to bring together two seemingly disparate theories to address an intractable issue – the translation of knowledge into quality healthcare. This represents an important point of departure from current KT discourse, much of which continues to superimpose artefacts like clinical practice guidelines onto complex healthcare context.

Background The Providing Enhanced Access to Child Health Services (PEACH) initiative at the Sydney Children’s Hospitals Network (SCHN) aims to reduce inequity in healthcare access and outcomes for priority population children and young people (including Aboriginal and/or Torres Strait Islander, culturally and linguistically diverse, from refugee or asylum seeker backgrounds, living in out-of-home care or recipients of the National Disability Insurance Scheme). Central to PEACH is active children and caregivers engagement through co-design, recognising the importance of understanding their experiences to facilitate enhanced healthcare provision. This qualitative study explored the experiences of priority population children and caregivers at SCHN before the implementation of PEACH initiatives, with the aim of identifying strengths, limitations, and recommendations for enhancing healthcare services tailored to priority population needs. Methods Guided by an experience-based co-design methodology, 28 qualitative semi-structured interviews were carried out with a total of 38 participants from priority population group(s) who had accessed care at SCHN. The data were analysed via inductive thematic analysis. Results The findings are presented through the lens of the concept of identity, delineated into personal and social identity. Personal identity is related to person before problem and demography, while social identity is linked to cultural responsiveness. Participants emphasised both the significance of social identities in health service design, and the importance of an individualised approach that recognises and respects their unique personal identities within the broader social context. Conclusions This research advocates for a person-centred approach to healthcare delivery that recognises and responds to the dynamic interconnected relationship between personal and social identities.

Background Embedding youth peer workers within youth mental health services is critical to integrating the personal lived experience of recovery‐oriented and trauma‐informed approaches in care and helping young people to make sense of the system. However, research into the optimal engagement of youth peer workers is lacking, which limits opportunities for integrating personal lived experience within care. This paper evaluated peer workers' experiences of integration into youth mental health services to identify strategies for optimal integration. Methods Best‐fit framework synthesis was used to investigate peer worker experiences within youth mental health services using data collected from 12 peer workers through semi‐structured interviews. Themes were coded according to the key components for integrating youth peer workers into services as presented by previous guidelines (role clarity, training, supervision, professional development, agency and co‐design, non‐peer education and relationships, communication, well‐being, ongoing evaluation, remuneration and policy). Findings Key areas of successful implementation of youth peer workers included communication networks between peers, supervision and non‐peer relationships. Areas for further development included improved role clarity, training, policy and remuneration and improvement in non‐peer staff understanding of peer roles. Conclusions The best practice framework has utility as a model for guiding implementation evaluation of youth peer workforce into mental health services. The findings highlight the need for supporting employment pathways for youth peer workers. Further, there is a need for professional development opportunities to increase the integration of peer workers into youth mental health services. Patient or Public Contribution One of the first authors is a youth peer worker who was involved in the design and conduct of the study, interpretation of the data and preparation of the manuscript.