Public Health Research & Practice最新文献

Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted healthcare systems worldwide, causing substantial changes to routine healthcare delivery. National and international modelling studies have predicted adverse impacts of this disruption. This study aimed to assess the real-world impact of the COVID-19 pandemic on quality of care and outcomes for patients with lung cancer in New South Wales (NSW).

Study type: Pre-post observational cohort study using data prospectively collected for the Embedding Research (and Evidence) in Cancer Healthcare (EnRICH) Program.

Methods: The study population comprised 2000 patients with lung cancer from six specialist cancer centres in metropolitan and regional NSW. We split this population into two cohorts: the pre-COVID-19 cohort (1143 patients diagnosed from 8 September 2016 to 10 March 2020) and the post-COVID-19 cohort (857 patients diagnosed from 11 March 2020 to 28 October 2021). The main outcome measures were lung cancer clinical quality indicators, 1-year and 2-year overall survival, and patient-reported health-related quality of life and psychological distress.

Results: Patient and disease characteristics (e.g. age, gender, cancer stage) were similar for the pre-and post-COVID-19 cohorts, except for histology (non-small cell lung cancer (NSCLC) 88% in the pre-COVID-19 cohort and 84% in the post-COVID-19 cohort; p = 0.008) and region of residence (62% and 55%, respectively, lived in metropolitan areas; p = 0.002). Compared to the pre-COVID-19 cohort, fewer patients in the post-COVID-19 cohort received a diagnosis within 28 days of the first investigation of symptoms (clinical diagnosis: 77% compared with 72%; p = 0.017, pathological diagnosis: 60% compared with 53%; p = 0.005). However, the median time from the first investigation of symptoms to treatment initiation did not differ. One- and 2-year overall survival, quality of life and psychological distress did not differ between cohorts.

Conclusions: This analysis found that the COVID-19 pandemic did not significantly adversely affect quality of care and outcomes for patients with lung cancer in NSW. Reassuringly, these results suggest that prioritising urgent health services, such as cancer care and implementing protective mitigation measures were effective in avoiding the predicted adverse outcomes of healthcare service disruption.

Objective: More than 95% of melanomas in Australia are caused by UV radiation from the sun. Young adults are particularly at risk, with 18-24-year-olds spending more time in the sun and protecting their skin less than older adults. A new mass media campaign was delivered in New South Wales, Australia, to motivate this hard-to-reach group to protect their skin from harmful UV radiation. This paper shares learnings from this campaign for public health educators working across diverse fields.

Program: Guided by audience research and testing, the campaign combined fear-based and self-efficacy messaging. UV radiation was portrayed as arrows descending from the sky, transforming it into a visible and ever-present threat. High-reach channels such as cinema, outdoor advertising, online videos, audio apps and social media were used to reach the audience.

Methods: The campaign was evaluated through an online tracking survey (n = 750, 18-24-year-olds) measuring prompted recognition, message take-out, key diagnostics, and self-reported sun protection intentions and behaviours.

Results: The evaluation found that 57% of survey participants recognised the campaign when prompted. Among those that recognised the campaign, 76% said they had used sun protection when outdoors over the summer campaign period (vs 64% of non-recognisers, p < 0.05), and 45% said they had adopted at least three of the five sun protection behaviours (Slip, Slop, Slap, Seek and Slide) 'always' or 'often' (vs. 36% of non-recognisers, p < 0.05).

Lessons learnt: A mass-media campaign that aimed to elicit emotional (fear) and cognitive (perceived efficacy) responses and which drew upon social and heuristic cues was associated with greater self-reported sun protection among the target audience. Delivering a combination of message strategies simultaneously within a campaign tailored to young adults may be more effective than adopting a more singular focus.

A new discipline, implementation science, has emerged in recent years. This has resulted in confusion between what 'implementation science' is and how it differs from real-world scale-up of health interventions. While there is considerable overlap, in this perspective, we seek to highlight some of the differences between these two concepts in relation to their origin, drivers, research methods and implications for population impact and practice. We recognise that implementation science generates new information on optimal methods and strategies to facilitate the uptake of evidence-based practices. This new knowledge can be used as part of any scaling-up endeavour. However, real-world scale-up is influenced to a much greater extent by political and strategic needs and key actors and generally requires the support of governments or large agencies that can fund population-level scale-up. Furthermore, scale-up often occurs in the absence of any evidence of effectiveness. Therefore, while implementation science and scale-up both ultimately aim to facilitate the uptake of interventions to improve population health, their immediate intentions differ, and these distinctions are worth highlighting for policymakers and researchers.

Co-creation is a participatory design approach that leverages the experiential knowledge of non-academic actors. It is increasingly adopted in public health research to enhance the relevance, acceptability, and impact of interventions. This perspective article provides a practical introduction to co-creation, its application, and benefits and considerations for public health researchers. Based on the authors' experiences with co-creation in public health, four key considerations for co-creation are outlined: 1) the selection of collaborators (those participating in the co-creation process) and their power dynamics and interests; 2) frameworks and guidelines for the co-creation process; 3) capacities needed to successfully apply a co-creation approach, such as emotional intelligence and adaptability; and 4) practical matters, such as resources and ethics approval. These insights serve as a practical introduction for public health researchers considering the application of co-creation in their projects to facilitate more effective and impactful, user-centered research designs and interventions.

Objectives and importance of study: Australian children frequently travel overseas, but little is known about their travel-related morbidity. We aimed to describe the spectrum of illness and injury in returned travellers presenting to the largest paediatric referral centre in NSW, the Children's Hospital at Westmead (CHW).

Study type: Observational cohort study.

Methods: In the 18 months immediately before the COVID-19 pandemic (2018-2020), we prospectively collected demographic, travel and clinical data from children with travel-acquired illness or injury identified by active surveillance of CHW Emergency Department attendees and referrals to the infectious diseases service.

Results: We identified 587 returned child travellers with an illness or injury associated with overseas travel. Most were aged younger than 5 (62.8%) and had travelled within the Asia-Pacific region (84.6%). The main reason for travel, where recorded (50.3%), was visiting friends and relatives (VFR)(65.4%). Most travellers (90.1%) had a common childhood infection, illness or injury coincidentally acquired during travel, including respiratory infection (37.5%), acute diarrhoea (15.7%) and nonspecific febrile illness (13.1%). Exotic/nonendemic infections were uncommon (9.9%, including potential rabies exposure) but were associated with much higher admission rates than 'cosmopolitan' (globally distributed) diseases (74.2% vs 21.9%). Most of these occurred in VFR travellers (86.3%); enteric fever, largely acquired in South Asia, predominated (51.7%). One in five admitted patients had a disease for which specific pretravel vaccination is available. Receipt of pretravel vaccines was infrequently recorded.

Conclusions: Returned child travellers in Western Sydney frequently presented with respiratory infections and may be a key population for surveillance of imported respiratory viruses. The burden of exotic disease was small and borne by VFR travellers. Travel-related illness in Western Sydney could be reduced by health education of travellers and targeted pretravel vaccination, especially typhoid vaccination for VFR travellers to South Asia. Universal, systematic screening of emergency department attendees for recent overseas travel would improve surveillance of travel-related illness.

Objective: The Australian Government Tackling Indigenous Smoking (TIS) program aims to reduce tobacco use among Aboriginal and Torres Strait Islander peoples, delivering locally tailored health promotion messages, including promoting the Quitline. We aimed to analyse data on use of the Quitline by Aboriginal and Torres Strait Islander peoples nationally, specifically in TIS and non-TIS areas.

Methods: We analysed usage of the Quitline in seven jurisdictions across Australia in areas with and without TIS teams (TIS areas and non-TIS areas respectively) between 2016-2020. Demographic and usage characteristics were quantified. Clients and referrals as a proportion of the current smoking population were calculated for each year, 2016-2020.

Results: From 2016-2020, 12 274 Aboriginal and Torres Strait Islander people were clients of the Quitline in included jurisdictions. Most (69%) clients were living in a TIS area. Two-thirds (66.4%) of referrals were from third‑party referrers rather than self-referrals. Overall, between 1.25% and 1.62% of Aboriginal and Torres Strait Islander peoples who currently smoked were clients of Quitline (between 1.15-1.57% in TIS areas and 0.82-0.97% in non-TIS areas).

Conclusions: The Quitline provided smoking cessation support to approximately 2500-3000 Aboriginal and Torres Strait Islander clients annually between 2016-2020. Referrals from third parties including Aboriginal and Torres Strait Islander services are an important pathway connecting community members to an evidenced-based cessation support service.

Objectives and importance of the study: Pharmacist-administered vaccination has expanded in Australia but has not been comprehensively assessed. We aimed to assess the pharmacists' role in vaccination in Australia before and during the first year of the COVID-19 pandemic, as well as the completeness of data on pharmacist-administered immunisations.

Study type: Cross-sectional study.

Methods: We analysed data on pharmacist-administered vaccinations that were reported to the Australian Immunisation Register (AIR) between 2016 and 2019, categorised by gender, jurisdiction, age group and vaccine type. We conducted a national survey of community pharmacists providing vaccination services during June and July 2020 to understand how pharmacists record and report vaccinations to the AIR. We assessed data completeness by comparing the number of vaccinations reported by surveyed pharmacists to the number recorded on the AIR.

Results: 576 780 pharmacist-administered vaccinations were recorded on the AIR between 2016 and 2019, of which 94.7% were influenza vaccines. The proportion of vaccinations given by pharmacists increased each year, from <0.001% in 2016 to 2.7% in 2019. Between 2017 and 2019, rates of pharmacist-administered vaccinations were highest among people aged 60-64 years (2046 per 100 000 people) and those living in regional areas (1074 per 100 000 people). Among 243 survey respondents, 57.8% (126/223) reported vaccinations to the AIR automatically via software, 27.8% (62/223) manually entered data and 13.5% (30/223) used both methods. Of the 87 665 vaccination encounters recorded by 121 respondents, 82.2% (72 045/87 665) were recorded on the AIR. There were more AIR-recorded encounters from those who reported automatically via software (84.8% [49 309/58 134]) than from those who manually entered data (68.3% [12 127/17 746]).

Conclusions: Pharmacists have an increasing role in providing vaccination services in Australia, with great potential to improve coverage among adults and populations in regional locations. Measures introduced during the COVID-19 pandemic may have increased the uptake of electronic methods of recording and reporting data, which can improve data completeness. Our results provide an assessment of the first 5 years of pharmacist vaccination services in Australia, against which future evaluations of the impacts of policy changes during the COVID-19 pandemic can be compared.

Background: An asymptomatic COVID-19 rapid antigen testing (RAT) screening program was implemented in Victorian schools in January 2022, to support keeping schools open throughout the pandemic. This study explored compliance with the program among caregivers from priority populations in Victorian mainstream and specialist schools.

Methods: We conducted semi-structured interviews between 7-31 March 2022 with caregivers of school-aged children participating in the RAT program in Victoria. Participants were asked about awareness, acceptability, compliance, frequency, and barriers to testing. Recordings were transcribed and deductively analysed using a framework approach.

Results: Fifty caregivers participated. They expressed confusion about the 'recommended' program, assuming it was mandatory. Caregivers wanted notification from schools of positive cases to increase motivation for compliance. Culturally and linguistically diverse (CALD) families were compliant; however, in-language resources were limited. Aboriginal or Torres Strait Islander (Koori) families tested less regularly and received information from their community rather than school. Caregivers of children living with disabilities reported behavioural challenges to testing, resulting in distress or non-compliance, and received non-specific information for their children.

Conclusions: To increase engagement with future surveillance programs, caregivers need clarity about optionality, conducting tests, reporting results, and timely notification of cases. Requirements unique to each priority population include: accurate in-language information for CALD caregivers, community-led communication for Koori caregivers, tailored information, less testing, and flexibility for caregivers of children living with a disability. Keeping schools open and having tailored strategies to ensure equitable access for priority populations are essential for future pandemic management.

Objectives and importance of study: In the public service context, co-design is novel and ever-expanding. Co-design brings together decision-makers and people impacted by a problem to unpack the problem and design solutions together. Government agencies are increasingly adopting co-design to understand and meet the unique needs of priority populations. While the literature illustrates a progressive uptake of co-design in service delivery, there is little evidence of co-design in policy development. We propose a qualitative study protocol to explore and synthesise the evidence (literary, experiential and theoretical) of co-design in public policy. This can inform a framework to guide policymakers who co-design health policy with Aboriginal and Torres Strait Islander people.

Methods: The study design is informed by a critical qualitative approach that comprises five successive stages. The study commences with the set-up of a co-design brains trust (CBT), comprising people with lived experience of being Aboriginal and Torres Strait Islander who have either co-designed with public agencies and/or have health policymaking expertise (stage 1) The brains trust will play a key role in guiding the protocol's methodology, data collection, reporting and co-designing a 'Version 1' framework to guide policymakers in co-designing health policy with Aboriginal and Torres Strait Islander people (the framework). Two realist evaluations will explore co-design in health policy settings to understand how co-design works for whom, under what circumstances, and how (stages 2 and 3) The findings of the realist evaluations will guide the CBT in developing the framework (stage 4). A process evaluation of the CBT setup and framework development will assess the degree to which the CBT achieved its intended objectives (stage 5).

Conclusions: The proposed study will produce much-needed evidence to guide policymakers to share decision-making power and privilege the voices of Aboriginal and Torres Strait Islander people when co-designing health policy. Learnings from this translational research will be shared via the CBT, academic papers, conference presentations and policy briefings.

Co-creation is a participatory design approach that leverages the experiential knowledge of non-academic actors. It is increasingly adopted in public health research to enhance the relevance, acceptability, and impact of interventions. This perspective article provides a practical introduction to co-creation, its application, and benefits and considerations for public health researchers. Based on the authors' experiences with co-creation in public health, four key considerations for co-creation are outlined: 1) the selection of collaborators (those participating in the co-creation process) and their power dynamics and interests; 2) frameworks and guidelines for the co-creation process; 3) capacities needed to successfully apply a co-creation approach, such as emotional intelligence and adaptability; and 4) practical matters, such as resources and ethics approval. These insights serve as a practical introduction for public health researchers considering the application of co-creation in their projects to facilitate more effective and impactful, user-centered research designs and interventions.