This qualitative research project used a focus group methodology and thematic analysis to identify and interpret issues arising from workshop discussions. Participants were also encouraged to reflect on issues, provide further input and act locally on ideas whilst the wider research was still in progress, consistent with qualitative action research principles.
A Project Reference Group (PRG) was established prior to commencement of the workshops, which consisted of the two researchers and eight health service personnel. These included health service managers, rural nurses and allied health workers currently working within HNE Health. PRG members were nominated by the HNE Health Executive Team on the basis of particular areas of practice, location, responsibility or expertise relevant to the Project. The purpose of the PRG was to provide practical advice and assistance on the conduct and direction of the project; provide feedback after the initial workshop; and to review and provide practical comment on preliminary results and recommendations.
Communities were selected to host a focus group or 'workshop' on the basis of size and geographic spread across the Hunter New England region of rural NSW. Each workshop was held in a town with a population between 5,000 and 30,000 people. Communities were located in six of the seven rural management clusters of HNE Health (Figure ).
Location of communities where older health workers project workshops were held within Hunter New England Area Health Service, NSW, Australia.
Local health service managers or their representatives were contacted to assist in arranging the workshop and to make sure all health service staff knew about it. Notification of each local workshop, with an invitation to participate directed at staff '50 years and over', was circulated 2-3 weeks in advance, through regular workplace communication channels. This included staff email networks, staff meetings, staff notice boards and word-of-mouth. Health service managers in communities within an hour's drive of the hosting health service were also asked to inform their staff about the workshop.
A convenience sample of 80 older health workers attended the six workshops between August and November 2008. Four were men and an average of 13 participants attended each workshop. Demographic information on the age and characteristics of individual participants was not collected, but each group was asked to indicate their general work experience and fields of practice. Consistent with an 'over 50' cohort, a number of participants had worked within the health service for 30 years or more.
Participants were mainly drawn from the nursing and allied health professional groups, who were the focus of recruitment efforts. Allied health fields of practice included radiography, occupational therapy, diversional therapy, physiotherapy, social work and psychology. Nursing sector participants included registered nurses and enrolled nurses from community health, aged care, general hospital wards, operating theatres, sterilising departments, midwifery, emergency departments and health service management. A small number were from other professional groupings (less than 10%), encompassing 'other professional, para-professional and clinical support staff' (Aboriginal health), 'corporate services' (clerical administration) and 'hotel services' (catering). The majority of participants worked regular office hours, although others had worked shift work in the recent past.
Participation was completely voluntary and informed consent was obtained from participants prior to their involvement. At the outset of each workshop, the purpose of the research was explained to participants by the lead researcher, who acted as the group facilitator. A 'participant information sheet' was provided outlining further details; and after opportunity for questions, participants were asked to sign a formal consent form prior to commencement of discussions.
Within each workshop, participants were asked to identify and describe:
• work tasks and aspects of work that have become more difficult for rural health workers as they have become older;
• age-related changes and other exacerbating factors contributing to these difficulties
Responses focusing on these questions were recorded by participants during small break-out groups of 3-5 people. In particular, participants were asked to list difficulties in a table; and to record ideas on the age-related changes and exacerbating factors that contributed to each of these difficulties in an adjacent column. One or two items from each small group were selected for further discussion by the larger group, enabling other group members to contribute and/or debate ideas. One researcher had the designated task of taking detailed notes during the course of these larger group discussions, which supplemented the data recorded by participants on the small group worksheets.
Thematic content analysis was then used to identify issues arising from workshop discussions. Notes and worksheets were reviewed after each workshop and information sorted into categories that focused on defining difficulties associated with specific tasks, variation within work contexts and relationships between categories. Categories were progressively reviewed and used to help guide discussion in subsequent workshops until no new information on the subject arose. Themes relating to difficulties were tabulated moving from (1) particular tasks and specific workplace settings, to (2) more general aspects of work and broader settings.
Participants were invited to reflect on ideas shared in their 'workshop' and act locally on issues whilst the wider research project was still in progress. Preliminary findings from all workshops were sent to participants, who were given opportunity to provide further feedback and ideas prior to final recommendations being made.
The research protocol was approved by the Hunter New England Human Research Ethics Committee (Reference 08/05/21/4.06). This was consistent with local health service requirements and research ethics principles of the World Medical Association Declaration Of Helsinki [23