Collaboration for Research in Understanding Stigma in Healthcare (CRUSH)

CRUSH – Research Focus Overview

Stigma can fuel discrimination and social inequalities while denying social acceptance and reduce opportunities for the individuals/groups. This can lead to negative implications for health and wellbeing through experiences and feelings of shame, blame, hopelessness, distress, secrecy, loneliness and isolation. Stigma is also frequently cited as the main reason people do not access health care.

CRUSH (Collaboration for Research in Understanding Stigma in Healthcare) is focused on advancing knowledge and understanding on stigma to improve care provision and health outcomes for the individuals/groups experiencing stigma. We are committed to undertaking evidence-based research on stigma and discrimination in healthcare to support stigma reduction efforts through education, prevention, care, and treatment.

Associate Professor Cindy Jones (Lead) | Dr Amy Bannatyne (Co-Lead)

We aim to:

explore and understand the different manifestations of stigma, including stigma experiences (e.g., experienced, anticipated, internalised, perceived, and secondary) and stigma practices (e.g., stereotypes, prejudice, discriminatory behaviour);
understand how stigma manifests in policy, resource allocation decision making, law and other systemic context;
develop and validate stigma and discrimination related metrics (e.g. instruments and tools);
address stigma in health professional education;
develop and evaluate stigma education, prevention, and care interventions or programs; as well as
lead or foster partnerships among key stakeholders to create and implement strategies and policies that reduce or eliminate stigma and discrimination in healthcare, the communities in which people reside, and the communities which engage with them.

CRUSH Research Group Academic Staff and HDR students

Research projects, grants and publications

Supporting sexuality in ageing and dementia
Project title: Supporting expression of sexuality by older people with dementia in long-term care from a person-centred care approach: Implementation evaluation of the “ISEP” tool.

Project aim: Dementia causes many changes in people’s lives, including changes to intimate relationships, sex & expression of sexuality. People living with dementia’s (including lesbian, gay, bisexual, trans and intersex LGBTI individuals) ability to express their sexuality, while important to their physical and sexual health, quality of life and psychosocial well-being, is a stigmatised and neglected aspect of care. The project addresses this existing challenge by developing and evaluating a tool to improve the care and support of people with dementia in long-term care settings from a person-centred approach.

Funding: Jones, C., Moyle, W., & van Haitsma, K. (2019). Supporting expression of sexuality by older people with dementia in long-term care from a person-centred care approach. Dementia Australia Research Foundation Grant. $75,000.

Publications:
- Jones, C., & Moyle, W. (2018). Are gerontological nurses ready for the expression of sexuality by people living with dementia [Editorial]. Journal of Gerontological Nursing, 44(5), 2-4. DOI: 10.3928/00989134-20180413-01
- Chen, Y. H., Jones, C., & Osborne, D. (2017). Exploratory study of Australia’s aged care staff’s knowledge and attitudes of later life sexuality. Australasian Journal on Ageing, 36(2), E35-E38. DOI: 10.1111/ajag.12404
- Jones, C., & Moyle, W. (2016). Sexuality & dementia: An E-learning resource to improve knowledge and attitudes of aged care staff. Educational Gerontology, 42(8), 563-571. DOI: 10.1080/03601277.2016.1205373
For further information, please contact A/Prof Cindy Jones [email protected]

Understanding eating disorders

Project title: Can we fight stigma with science? The effect of etiological framing on attitudes toward eating disorders and the impact on volitional stigma.

Project aim: Stigma is an unfortunate and pervasive reality for individuals experiencing an eating disorder, particularly anorexia nervosa. Stigma in relation to eating disorders typically manifests in the perception of eating disorders as a voluntary or self-inflicted illness, often referred to as “volitional” or “blame-based” stigma. This project aims to improve attitudes toward eating disorders by understanding lived experiences of treatment and stigma and using this information to explore the impact etiological framing in different study designs and populations.

Publications:

Bannatyne, A., & Stapleton, P. (2017). Attitudes toward anorexia nervosa: Volitional stigma differences in a sample of pre-clinical medicine and psychology students. Journal of Mental Health, 26, 442-448. doi:10.3109/09638237.2016.11149801
Bannatyne, A., & Stapleton, P. (2016). Eating disorder patient experiences of volitional stigma within the health care system and views on biogenetic framing: A qualitative perspective. Australian Psychologist, 53, 325-338. doi:10.1111/ap.12171
Bannatyne, A., & Stapleton, P. (2015). Educating medical students about anorexia nervosa: A potential method for reducing the volitional stigma associated with the disorder. Eating Disorders: The Journal of Treatment and Prevention, 23, 115-133. doi:10.1080/10640266.2014.976102
Bannatyne, A., & Abel, L. M. (2015). Can we fight stigma with science? The effect of etiological framing on attitudes toward anorexia nervosa. Australian Journal of Psychology, 67, 38-46. doi:10.1111/ajpy.12062

For further information, please contact Assist Prof Amy Bannatyne at [email protected]

Project title: Disordered eating in pregnancy: The development and validation of the Disordered Eating Attitudes in Pregnancy Scale.

Project aim: A growing body of research has suggested pregnancy may represent a period of vulnerability for the onset, re-emergence, or exacerbation of disordered eating; however, such symptoms are often undetected and undisclosed in pregnancy due to stigma. This research initially aimed to improve the identification of disordered eating in pregnancy by developing a brief screening tool that could be easily implemented by antenatal clinicians. Preliminary research found the Disordered Eating Attitudes in Pregnancy Scale (DEAPS) to have strong psychometric properties, with results revealing that in a sample of 450 women, almost a quarter had possible symptoms of disordered eating. Future research aims to further elucidate the validity of the DEAPS in different samples, study designs, settings, and administration methods.

Funding: This project was supported by an Australian Postgraduate Award ($73,462.00).

Publications:

Bannatyne, A., Watt, B., Stapleton, P., & MacKenzie-Shalders, K. (under review). Disordered eating in pregnancy: The development and validation of the Disordered Eating Attitudes in Pregnancy Scale (DEAPS).
Bannatyne, A., McNeil, E., Stapleton, P., Watt, B., & MacKenzie-Shalders, K. (in press). Disordered eating measures validated in pregnancy populations: A systematic review. Eating Disorders: The Journal of Treatment and Prevention.
Bannatyne, A., Hughes, R., Stapleton, P., Watt, B., & MacKenzie-Shalders, K. (2018). Consensus on the assessment of disordered eating in pregnancy: An international Delphi study. Archives of Women’s Mental Health, 21, 383- 390. doi:10.1007/s00737-017-0806-x
Bannatyne, A., Hughes, R., Stapleton, P., Watt, B., & MacKenzie-Shalders, K. (2018). Signs and symptoms of disordered eating in pregnancy: A Delphi consensus study. BMC Pregnancy & Childbirth, 18, 262. doi:10.1186/s12884-018-1849-3

For further information, please contact Assist Prof Amy Bannatyne at [email protected]

Enhancing mental health and wellbeing

Project title: Understanding student mental health and wellbeing at Bond University: An institution-wide project.

Project aim: The aim of this project is to establish baseline data of student mental health and wellbeing at Bond University through administration of an institution-wide survey, co-designed with students representatives/leaders, staff members from various faculties and central services, and university management, with expert input from Bupa. From this data, we hope to: (i) obtain insight into the prevalence and magnitude of mental-ill health; (ii) understand the effect of the trimester model on student health and wellbeing; (iii) determine whether resourcing for support services is adequate and sustainable; (iv) identify possible evidence-based prevention and response strategies; and (v) understand barriers to help-seeking (e.g., stigma) and identify strategies to remove/reduce these barriers.

CRUSH Affiliated Investigators: Assist Prof Amy Bannatyne, Prof Kirsty Forrest & A/Prof Jo Bishop

For further information, please contact Assist Prof Amy Bannatyne at [email protected]

Project Title: Intervention development, efficacy and effectiveness testing and knowledge translation in child and youth mental health.

Project Aim: Previous studies and mental health bodies have identified top priorities where research is needed in the field of children and young people’s mental health. This proposed project aims to improve outcomes for children and young people through research into one of the identified priority areas, that is intervention development and effectiveness. The research will focus on the development, efficacy and effectiveness of interventions and translation of research evidence into practice in child and youth mental health settings. The research will be conducted in collaboration with Child and Youth Mental Health Services, education providers and social care departments.

For further information, please contact Assist Prof Tawanda Machingura [email protected]

Project title: Employment outcomes for mental health consumers.

Project aim: Meaningful employment has been shown to improve self-esteem, increase personal empowerment and social contact, social identity and status. Reduced clinical symptoms, the development of personal wellbeing and higher levels of functioning have also been associated with employment. However, despite the value that work has for people with a mental illness, competitive job tenure remains relatively brief for people with a mental illness and they remain under-represented in the labour force.

Publications:

Machingura, T., Lloyd, C. (2017). Mental health occupational therapy and supported employment. Irish Journal of Occupational Therapy, 45(1): 52-57
Williams, P. l., Lloyd, C., King, R., Waghorn, G., Machingura, T., (2015). Implementing evidence-based practices in supported employment on the Gold Coast for people with severe mental illness. Australian Occupational Therapy Journal 62(5), 316-325. doi: 10.1111/1440-1630.12202
Machingura, T. (2004). Employment status of mental health consumers: A pilot study. New Zealand Journal of occupational therapy 51 (1): 28-29

For further information, please contact Assist Prof Tawanda Machingura [email protected]

Project title: The use of sensory modulation.

Project aim: The use of sensory modulation in mental health evolved in response to the demand for recovery-oriented interventions to reduce seclusion and restraint for individuals with schizophrenia and other mental health conditions. Sensory modulation is an overarching term given to a suite of tools used to assist mental health service users to moderate their responses when distressed. Sensory tools can, for example, be used to help service users who are agitated to become calmer, those who are anxious to feel less so, or help activate service users who are depressed. Clinicians also use sensory modulation to help some service users to lessen feelings of self-harm or to manage violent situations. This project includes an ongoing multisite PhD project which utilises a mixed methods research design to investigate the effectiveness of sensory modulation interventions in adults with schizophrenia.

Funding: This project is funded by Griffith University, PhD Grant $3000.

Publications:

Machingura, T., Kaur, G., Lloyd, C., Mickan, S., Shum, D., Rathbone, E. and Green, H. (2019). An exploration of sensory processing patterns and their association with demographic factors in healthy adults. Irish Journal of Occupational Therapy, Vol. ahead-of-print No. ahead-of-print. https://doi.org/10.1108/IJOT-12-2018-0025

Machingura, T., Lloyd, C. (2019). What Causes Patient Aggressive Behaviours in Healthcare Settings? Psychology Behavioral Science International Journal. 10(5):555796. DOI: 10.19080/PBSIJ.2019.10.555796

Machingura, T., & Lloyd, C. (2018). Sensory modulation optimises performance of clinicians. International Journal of Therapy and Rehabilitation. 25, 2, p. 49-50 2 p.
Machingura, T., & Lloyd, C. (2017). Sensory approaches in mental health: Contemporary occupation-based practice or a redundant medical approach? International Journal of Therapy and Rehabilitation. 24(5), 189-190.
Machingura, T., Shum, D., Molineux, M., & Lloyd, C. (2017). Effectiveness of Sensory Modulation in Treating Sensory Modulation Disorders in Adults with Schizophrenia: A Systematic Literature Review. International Journal of Mental Health and Addiction, 16, 3, p. 764-780 17 p.
Machingura, T., & Lloyd, C. (2017). A reflection of success factors in implementing sensory modulation in an acute mental health setting. International Journal of Therapy and Rehabilitation, 24(1): 35-39 DOI:10.12968/ijtr.2017.24.1.35
Lloyd, C., Williams, P. L., & Machingura, T. (2015). A process for developing a student led programme in an acute mental health setting. New Zealand Journal of Occupational Therapy, 62 (2), 67–70
Lloyd, C., King, R., Machingura, T. (2014). An investigation into the effectiveness of sensory modulation in reducing seclusion within an acute mental health unit. Advances in Mental Health Journal 12(2): 93-100 DOI:10.5172/jamh.2013.3800

For further information, please contact Assist Prof Tawanda Machingura [email protected]

Professional education on stigma-related health areas

Project title: Health literacy, dementia knowledge, and digital health preference in health profession students.

Project aim: With increasing interest in dementia prevention and risk reduction in an ageing population, it is important to assess future health professionals’ knowledge of dementia risk factors, health literacy and preferences for digital interventions. A cross-universities collaboration between University of Queensland, Bond University, University of Southern Cross, Central Queensland University and University of Southern Queensland, this projects aims to increase understanding of future health professional dementia knowledge in order to develop optimal possible pathways to target interventions to improve dementia education and care provision.

For further information, please contact A/Prof Cindy Jones [email protected]

Project title: Disruptive technologies in medical education: The effectiveness of technology enhanced multimodal representations in health sciences.

Project aim: Modern educational techniques are increasingly using technology to enhance student learning experiences. This is particularly important in biomedical and medical education, where 3D models can greatly impact students’ understanding of the human body and its structure. Research has shown that manipulation of a 3D object during perceptual learning leads to more efficient comprehension of the object and when made available for tactile exploration, students gain greater skills in recognition and awareness of anatomical structures. This research project will investigate the effectiveness of virtual and 3-dimensional environments on student learning within biomedical sciences and medicine. Virtual Reality, tablet-based applications, holographic technology and lecture recordings will be examined, and the outcome of this research study will provide a greater understanding as to the most effective methods for teaching. Lessons covering education in dementia, Alzheimer’s disease, asthma, multiple sclerosis, autism and other presentations will form part of this series of studies.

CRUSH affiliated investigators: A/Prof Christian Moro, A/Prof Cindy Jones, Charlotte Phelps & Dominique Jones

For further information, please contact A/Prof Christian Moro at [email protected]

Project title: Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand.

Project aim: Meaningful consumer involvement in all aspects of service planning, implementation and evaluation is a core principle included in recovery-oriented mental health policies. It is also a requirement according to the National safety and quality health service standards. Additionally, the Australian occupational therapy competency standards (Occupational Therapy Board of Australia, 2018) mandate that occupational therapists develop and maintain collaborative relationships by recognising and managing inherent power imbalances. The broad intent of this study was to identify how mental health consumers are involved in mental health curricula in occupational therapy programs across Australia and New Zealand.

Publications:

Scanlan, J., Logan, A., Arblaster, K., Haracz, K., Fossey, E., Milbourn, B., … Machingura, T., Webster, J. (2020). Mental health consumer involvement in occupational therapy education in Australia and Aotearoa New Zealand. Australian Occupational Therapy Journal, 67(1), 83–93. https://doi.org/10.1111/1440-1630.12634
Lloyd, C., Williams, P., Machingura, T., Tse S. (2015). A focus on recovery: using the mental health recovery star as an outcome measure. Advances in Mental Health, 14(1), 57-64. http://dx.doi.org/10.1080/18387357.2015.1064341

For further information, please contact Assist Prof Tawanda Machingura [email protected]

Project title: Preparedness of occupational therapists to work with indigenous people in Australia.

Project aim: In Australia there are huge disparities in health outcomes between indigenous and non-indigenous people. When working with indigenous people, health professionals need to be both clinically and culturally competent to improve their health and wellbeing. In Australia the health outcomes of Aboriginal and Torres Strait Islander people have remained poor despite government efforts over many years. Previous studies have suggested that health professionals who are culturally competent are likely to have their clients achieving better health outcomes. This research aims to evaluate the preparedness of occupational therapists to work with indigenous people and to make suggestions for the improvement of preparedness of occupational therapists to work with indigenous people in Australia.

For further information, please contact Assist Prof Tawanda Machingura [email protected]

Project title: Beyond academic excellence: The role and impact of ability-based emotional intelligence and personality testing in the selection of medical students.

Project aim: Over the past decade, admissions committees at various medical schools have sought alternatives to traditional cognitive measures when selecting medical students. With communication skills, empathy, and interpersonal abilities increasingly valued and expected in health care, there has been a shifting focus to consider the emotional intelligence (EI) of applicants. In 2018, Bond University introduced ability based EI and personality testing in the selection process for the Medical Program. This project aims to examine the preliminary impact of the new selection mechanism on key performance outcomes (knowledge acquisition and clinical skills). The project also aims to aims to explore stakeholder perceptions and attitudes toward emotional intelligence testing.

Funding: This project is supported by an internal early career research seed scheme grant ($12,300.00).

CRUSH Affiliated Investigators: Assist Prof Amy Bannatyne, Prof Kirsty Forrest & A/Prof Cindy Jones

For further information, please contact Assist Prof Amy Bannatyne at [email protected]

Being equally well

“Stigma can be defined as a mark of shame, disgrace or disapproval which results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society.”

- World Health Organization, 2001

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