Public Health Research & Practice最新文献

Objectives and importance of study Evaluate the effectiveness of training workshops aiming to improve researchers' consumer and community involvement (CCI) related awareness, attitudes, and behaviours, and capture remaining barriers to CCI. Design Cross-sectional questionnaires. Setting University of Queensland researchers attending a CCI training workshop, facilitated by The Kids Institute between 2017 and 2023. Methods Participants were invited to complete two surveys with multiple choice and open-field items: (i) short term evaluation immediately following workshop attendance capturing reactions (ii) long-term evalution up to 6 years following attendance, including retrospective and current perceptions of confidence, motivation, capability, opportunity and reported behaviours. Survey items mapped to the Kirkpatrick model for training evaluations (reaction, learning, behaviour, and results) and COM-B model of behaviour change (capability, opportunity, and motivation). Multiple-choice responses were summarised with descriptive statistics and Chi-square analysis while open-field responses were mined qualitatively with content analysis. Results 17/183 and 104/240 individuals completed/partially completed Surveys 1 and 2 respectively. Survey 1 comments captured satisfaction with content and facilitation, and improved learning (Kirkpatrick's 'reaction' and 'learning'). Most Survey 2 participants were satisfied/highly satisfied with the workshop (n = 82/101, 81%) and agreed CCI was relevant (n = 88/90, 98%) or valuable (n = 86/89, 97%) to their research (COM-B 'motivation'). When completing Survey 2, a minority (n = 17/90, 19%) felt they were confident/very confident in implementing CCI prior to the workshop, which increased significantly post-workshop (n = 54/89, 61%) (P < 0.05). Participants reported moderate to high levels of capability (n = 78/83, 94%) and capacity (73/83, 88%) implementing CCI. The proportion of researchers implementing CCI in their research increased from 65% (n = 59/91) to 78% (n = 71/91) in the months/years post-workshop (P < 0.05). Researchers reported consistent CCI throughout the research journey and diverse models of involvement. Participants identified financial and administrative institutional barriers to optimal CCI implementation in research. These results align with all elements of the Kirkpatrick and COM-B models. Conclusions CI training improved researchers' CCI-related awareness, confidence and behaviours. However, the remaining barriers to optimal CCI implementation included logistical and institutional barriers, which reflect the opportunity element of COM-B. Thus, while CCI training of researchers is valuable and effective, institutions need to capitalise on these benefits with administrative and financial support.

Objectives: Exposure to unhealthy food and alcohol advertising in childhood and adolescence can influence preferences and later consumption. A fragmented and ineffective network of regulations and guidelines cover outdoor advertising of alcohol to children in Victoria, and regulations for unhealthy food/non-alcoholic drink are even less comprehensive. The aim of this study was to quantify the prevalence, size, and youth appeal of unhealthy food and drink (including alcohol) marketing at a major public transit hub in Melbourne, Southern Cross Station. This location is not subject to Department of Transport and Planning rules regarding placement of unhealthy product marketing that apply on other public transport in Victoria.

Methods: A manual audit of all advertisements located inside Southern Cross station (including on internal walls, hanging from the ceiling, freestanding on concourse, walkways and platforms) took place over 4 days in June-July 2024. From photographs, researchers categorised all advertisements as either alcohol, food/non-alcoholic drink (and then as either unhealthy [discretionary] or healthy [core, based on Australian Dietary Guidelines]), or other; and coded the size of the advertisement. Food/drink (including alcohol) advertisements were coded for presence of features with youth appeal using a validated measure. A total advertising power score for youth appeal was calculated. Mann-Whitney U tests examined differences in size and youth appeal between categories.

Results: A total of 858 advertisements were identified: n=213 (24.8%) were for food/non-alcoholic drinks (most of which were unhealthy, 83.1%), and n=202 (23.5%) were for alcohol. Alcohol advertisements were significantly larger than both non-alcoholic drink and food/non-alcoholic drink advertisements combined (each p<.0001), and had a significantly higher number of features with youth appeal and a higher youth appeal score than both non-alcoholic drinks and food/non-alcoholic drinks combined (all p<.0001-0.048). Youth appeal was also significantly higher for unhealthy than healthy food/non-alcoholic drink advertisements (p=0.039).

Conclusions: Advertisements for unhealthy food and drink including alcohol at Southern Cross station are prevalent, prominent, and powerful in their potential appeal to youth. A coherent and comprehensive approach to regulating the content of advertising on public transport and in outdoor spaces is needed to protect children and adolescents.

Objectives: Australia needs to increase linkage to viral hepatitis care and treatment to achieve the 2030 elimination targets. This study assessed the intervention of enhanced local public health (PH) follow-up of hepatitis B and hepatitis C notifications on linkage to care and treatment, compared to standard PH management, in the Barwon South West (BSW) and Gippsland regions in Victoria. Importance of study: Innovative models to increase viral hepatitis testing and linkage to care and treatment are required, especially in regional Australia.

Study type: Retrospective cohort study.

Methods: Study periods were March-August 2022 (standard PH management), and September 2022-February 2023 (enhanced local PH follow-up). Notifications from correctional facilities were excluded. Outcomes by study period compared time to complete hepatitis C diagnosis, hepatitis C treatment initiation, hepatitis B viral load measurement and referral for hepatitis B care. A Kaplan-Meier survival analysis and Cox regression model was performed.

Results: 190 notifications met inclusion criteria and 174 people were included in the analysis - 133 with hepatitis C and 41 with hepatitis B (16 were lost to follow-up). The probability of having an incomplete hepatitis C diagnosis within 180 days from notification was 2.33 (95% CI 1.40, 3.89) times higher among patients receiving standard PH management compared to enhanced local PH follow-up. The probability of not being referred to hepatitis B care within 90 days from notification was 2.78 times (95% CI 1.13, 6.82) higher among patients receiving standard PH management compared to enhanced local PH follow-up.

Conclusions: Enhanced local PH follow-up increased the proportion of hepatitis C notifications with a complete diagnosis and hepatitis B notifications referred to care. Local PH follow-up presents a unique opportunity to accelerate progress towards the 2030 viral hepatitis elimination targets in Victoria.

Objectives and importance of study: In recognition of the contribution that consumers can make to research, the National Health and Medical Research Council has called for the "active involvement of consumers and community members in all aspects of health and medical research". However, there are very few publicly available, easy to understand, co-designed resources that are targeted towards helping diverse consumers learn about specific research methods. The aim of this project was to co-design health literacy informed, plain language guides for qualitative and (quantitative) survey research.

Study type: Multi-phase participatory co-design study.

Methods: This project was underpinned by consumer engagement principles (respect and equity; trust; empowerment) and followed the Agency for Clinical Innovation's four co-design steps (Engage; Gather; Understand; Improve). The co-design team comprised people with experience in qualitative and survey research, including members of the Sydney Health Literacy Lab's community panel (Co-SHeLL). The project involved a series of online workshops to discuss each research method and learn from lived experience. Insights from the workshops informed drafts of the guides, which were iteratively revised with ongoing feedback. Health literacy resources including the Health Literacy Editor (assessing grade reading score, complex language, and passive voice) and the Patient Education Materials Assessment Tool (assessing understandability and actionability) were then applied to assess each guide.

Results: The two guides provide foundational knowledge about each research method, such as what research questions qualitative and survey research can answer, the types of data collected, and the types of analyses undertaken. Content provides clear examples of how consumers can be involved at each stage of the research process and best practice activities. The guides incorporate health literacy strategies where possible (Grade 9 reading level; 84% understandability and 83% actionability).

Discussion and conclusion: Through an iterative co-design process, we have developed research guides that seek to build consumers' capacity to engage more deeply in any given project, throughout the research process. They are positioned to support more equitable consumer engagement that better reflects the diversity of the communities we serve including those with diverse health literacy needs.

Background: Tuberculosis (TB) remains a global public health concern. In Australia, TB incidence is low but remains elevated among overseas-born individuals. This study investigates a TB cluster in a nonclinical hospital setting during the COVID-19 pandemic, highlighting transmission dynamics and the public health response.

Methods: A retrospective observational study was conducted using medical records and epidemiological contact tracing data within a tertiary hospital in New South Wales, Australia. Three screening rounds targeted office contacts in different air-conditioning zones. Whole genome sequencing (WGS) was used to assess Mycobacterium tuberculosis isolates.

Results: Five secondary cases of TB disease were identified following exposure to the index case, a non-clinical hospital employee with cavitating pulmonary TB. Among 233 identified contacts, 117 completed screening. Initially screened high-risk contacts (n=31) had high rates of TB disease (n=4; 12.9%) and newly detected IGRA-positivity (n=14; 45.1%), with lower rates in broader screening. Transmission likely occurred via prolonged office exposure. WGS linked a sixth TB case in a clinical healthcare worker to the cluster, with 26 secondary contacts screened.

Conclusion: This study underscores the potential for highly infectious TB transmission within Australian healthcare settings. Timely contact tracing, genomic surveillance, and pre-employment screening are essential for effective prevention and control.

Objectives and Importance of Study: Given the limited research on anti-racism interventions in health care, this study examined the effectiveness of bystander intervention training in the context of a comprehensive, multi-pronged approach to bystander anti-racism intervention for healthcare staff at one local health district in Sydney, Australia.

Study type: Pre-post-follow up study.

Methods: Data was collected over two years (January 2021 to February 2023), at three time points through an online survey. Supplementary data were also obtained from the public sector's state annual employee experience survey.

Results: The results showed that the training improved staff's understanding of racism and its impacts on health, increased their confidence and likelihood to respond to a racist incident at work, and increased their feelings of being supported by their workplace and/or manager to respond to an act of racism. Most staff were satisfied with the training, felt it was useful, and would recommend the training to colleagues. Supplementary data from the state annual employee experience survey showed that reported racism decreased slightly, and overall satisfaction with how their reported racism experience was handled more than doubled.

Conclusions: The local health district developed and evaluated the effectiveness of their comprehensive, multi-pronged Addressing Racism in Healthcare Strategy. The strategy included the foundational principles and strategies for effective anti-racism interventions in healthcare settings: laying the foundation for the anti-racism intervention, addressing institutional racism, and addressing personally-mediated racism. The Addressing Racism in Healthcare Strategy is a successful model that other health districts can adapt to promote inclusivity and cultural safety across the broader health system.

Objectives The objective was to examine demographic, social, and health trends over 24 years in a disadvantaged Sydney community through sustained household surveillance, demonstrating the feasibility of longitudinal community-level health monitoring for informing policy and service delivery whilst building local capacity. This study addresses a gap in Australian community-level health surveillance data, particularly for disadvantaged areas where health needs often differ from broader population patterns. Methods This repeated cross-sectional study conducted household surveys at six time points (1999, 2002, 2005, 2007, 2010, and 2022-2023) using quantitative measures including SF-12 Physical and Mental Health Component Summary scores, demographic data, and structured questions assessing community perceptions. Randomly selected households completed face-to-face interviews, telephone surveys (CATI), written questionnaires, online surveys, or drop-off/pick-up questionnaires lasting 20-45 minutes. Multilingual delivery accommodated Miller's diverse population. Local residents trained as interviewers in 2010 and 2022-2023 enhanced community engagement and trust. Results Adult participation ranged from 180 to 335 participants, with response rates from 17.1% (2007) to 51.6% (2022-2023). Notable demographic changes occurred: population ageing (31.6% over 65 by 2022-2023), growing overseas-born residents (49.8%), and rising educational achievement (55.5% with secondary qualifications or above). SF-12 Physical Component scores fell from 47.1 (2002) to 41.5 (2022-2023). SF-12 Mental Component scores dropped substantially from 48.8 (2002) to 30.6, nearly 20 points below Australian population norms. Social cohesion indicators varied across survey waves, with lower values in 2010 and higher values by 2022-2023. Health service enhancements between 2006-2010 yielded limited benefits, suggesting structural obstacles persist. Conclusion Community surveys were used to create health baselines, monitor changes during urban renewal, and inform policy and service planning. Sustained community-engaged surveillance through varied approaches to data collection is feasible in disadvantaged Australian contexts, uncovering localised health issues whilst supporting targeted public health interventions. Results reveal serious mental health deterioration warranting immediate attention alongside ongoing monitoring to tackle enduring inequalities and strengthen community capacity.

Objectives and importance of study This article documents rural/remote Aboriginal and Torres Strait Islander community laundries with the aim to support synergistic planning, implementation and evaluation. Study type An integrative scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: Scoping Reviews (PRISMA-ScR) guidelines. Methods The methodology incorporated semi-structured online searches for publicly available grey literature as well as scientific database searches to identify supporting peer-reviewed evidence. Extracted data included: laundry locations; details of establishment, operations and infrastructure; and health and wellbeing impact. Results At least 55 laundry facilities were established in 38 rural/remote Aboriginal or Torres Strait Islander communities between 2000 and 2024. Most were established within the past 10 years (n = 51, 93%) and operated by laundry service providers in partnership with local community organisations (n = 42, 76%). Laundry locations are publicly available, but we identified no substantiating evidence as to specific health and wellbeing impact. Conclusion There has been a recent rapid growth in rural/remote Aboriginal and Torres Strait Islander community laundries with plans for future expansion. Equitable access to laundry facilities is tied to human rights to water, sanitation, hygiene and dignity. However, the specific health benefits of community laundries (changes in rates of skin infections, acute rheumatic fever, and rheumatic heart disease) remain unclear. Rigorous evaluations are needed to inform public health policy and community decision making.

Objectives To explore the experiences of General Practitioners (GPs) when referring patients with positive bowel cancer screening tests for colonoscopy, and to identify enablers and barriers to increasing referrals to public nurse-led Direct Access Colonoscopy (DAC) services in New South Wales, Australia. Methods A mixed-methods study, with the design, analysis and interpretation informed by implementation science frameworks (COM-B and Theoretical Domains Framework). The quantitative component included an online survey of NSW GPs in July 2024 recruited through primary health care networks. Survey participants could opt-in for a follow-up, semi-structured online interview in August 2024. Descriptive statistics were produced with the quantitative data, by general practice setting and size of practice. Qualitative data were analysed deductively using theoretical frameworks. Results A total of 71 GPs completed the survey and 18 of those GPs participated in an interview. Ninety percent of survey participants were located in an area with a DAC service, but only 56% of these GPs were aware of the service (n = 51). All but two of the GPs who were aware of DAC had referred a patient to DAC in the previous 12 months (n = 34, 48%). The top three considerations for GPs when referring patients for a colonoscopy following a positive screening test were: average wait time for the procedure, patient finances and/or insurance, and the patient and/or service location. Key factors influencing general practitioner referral practices to DAC were knowledge gaps, unclear eligibility criteria, and no systemic prompts for referral to DAC. While DAC was valued for providing timely, cost-free access to colonoscopy, some GPs preferred private referrals because it was more timely and less burdensome for patients. GPs expressed concerns about specialist oversight and continuity of care, which led some to view DAC as an inferior referral pathway. Conclusions Feedback received from GPs in this study to improve DAC services and strengthen trust in referring to DAC were: increased communications about DAC to primary care; clear referral criteria, transparent wait times and simplified referral tools; statewide DAC service provision; clarifying specialist oversight and follow up of high risk patients; and targeted messaging about the DAC pathway using peer persuasion through professional networks.