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Daly JB, Doherty E, Tully B, Wiggers J, Hollis J, Licata M, Foster M, Tzelepis F, Lecathelinais C, Kingsland M. Effect of implementation strategies on the routine provision of antenatal care addressing smoking in pregnancy: study protocol for a non-randomised stepped-wedge cluster controlled trial. BMJ Open 2024; 14:e076725. [PMID: 38580367 PMCID: PMC11002428 DOI: 10.1136/bmjopen-2023-076725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 02/21/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Globally, guideline-recommended antenatal care for smoking cessation is not routinely delivered by antenatal care providers. Implementation strategies have been shown to improve the delivery of clinical practices across a variety of clinical services but there is an absence of evidence in applying such strategies to support improvements to antenatal care for smoking cessation in pregnancy. This study aims to determine the effectiveness and cost effectiveness of implementation strategies in increasing the routine provision of recommended antenatal care for smoking cessation in public maternity services. METHODS AND ANALYSIS A non-randomised stepped-wedge cluster-controlled trial will be conducted in maternity services across three health sectors in New South Wales, Australia. Implementation strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training and monitoring and feedback will be delivered sequentially to each sector over 4 months. Primary outcome measures will be the proportion of: (1) pregnant women who report receiving a carbon monoxide breath test; (2) smokers or recent quitters who report receiving quit/relapse advice; and (3) smokers who report offer of help to quit smoking (Quitline referral or nicotine replacement therapy). Outcomes will be measured via cross-sectional telephone surveys with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost effectiveness of the implementation intervention. Process measures including acceptability, adoption, fidelity and reach will be reported. ETHICS AND DISSEMINATION Ethics approval was obtained through the Hunter New England Human Research Ethics Committee (16/11/16/4.07; 16/10/19/5.15) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health policy-makers and health services to inform best practice processes for effective guideline implementation. Findings will also be disseminated at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry-ACTRN12622001010785.
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Affiliation(s)
- Justine B Daly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Armajun Aboriginal Health Service, Inverell, New South Wales, Australia
- Gomeroi Nation, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Jenna Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Milly Licata
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Michelle Foster
- Nursing and Midwifery Services, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Flora Tzelepis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
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Hollis JL, Deroover K, Licata M, Tully B, Farragher E, Lecathelinais C, Bennett N, Foster M, Pennell CE, Wiggers J, Daly J, Kingsland M. Antenatal care addressing gestational weight gain (GWG): a cross sectional study of pregnant women's reported receipt and acceptability of recommended GWG care and associated characteristics. BMC Pregnancy Childbirth 2024; 24:111. [PMID: 38321389 PMCID: PMC10845753 DOI: 10.1186/s12884-023-06158-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/25/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The Australian Clinical Practice Guidelines for Pregnancy Care recommend that during the first and subsequent antenatal visits all pregnant women are weighed; advised of recommended gestational weight gain (GWG), dietary intake and physical activity; and offered referrals for additional support if needed. The extent to which these recommendations are implemented and women's acceptability of recommended care is unknown. This study examines women's reported receipt and acceptability of guideline care for GWG, and characteristics associated with receipt of such care and its acceptability. METHODS From September 2018 to February 2019 a telephone survey was undertaken with women who had recently had a baby and received antenatal care from five public maternity services within a health district in Australia. Women self-reported their demographic characteristics, and receipt and acceptability of recommended GWG care. Receipt and acceptability of such care, and their association with the characteristics of women and the maternity service they attended, were examined using descriptive statistics and multivariable logistic regression analyses. RESULTS Of 514 women, 13.1% (95%CI:10.3-16.5) reported that they received an assessment of weight at both their first and a subsequent antenatal visit, and less than one third (30.0%; 95%CI:26.0-33.9) received advice on their recommended GWG range, dietary intake and physical activity. Just 6.6% (95%CI:4.8-9.1) of women reported receiving all assessment and advice components of recommended antenatal care, and 9.9% (95%CI:7.6-12.8) of women reported being referred for extra support. Women who were younger (OR = 1.13;95%CI:1.05-1.21), identifying as Aboriginal and Torres Strait Islander (OR = 24.54;95%CI:4.98-120.94), had a higher pre-pregnancy BMI (OR = 1.13;95%CI:1.05-1.21), were experiencing their first pregnancy (OR = 3.36;95%CI:1.27-8.86), and lived in a least disadvantaged area (compared to mid-disadvantaged area (OR = 18.5;95%CI:2.6-130.5) and most disadvantaged area (OR = 13.1;95%CI:2.09-82.4)) were more likely to receive recommended assessment and advice. Most Aboriginal (92%) and non-Aboriginal (93%) women agreed that recommended GWG care is acceptable. CONCLUSION Most women perceive antenatal care for GWG as recommended by the Clinical Practice Guidelines as acceptable, but did not receive it. When provided, such care is not delivered consistently to all women regardless of their characteristics or those of the maternity service they attend. There is a need for service-wide practice change to increase routine GWG care in pregnancy for all women.
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Affiliation(s)
- Jenna L Hollis
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Kristine Deroover
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Milly Licata
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Belinda Tully
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Gomeroi Nation, New England North West, NSW, Australia
| | - Eva Farragher
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Nicole Bennett
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, NSW, 2305, Australia
| | - Michelle Foster
- Hunter New England Local Health District Nursing and Midwifery Services, Newcastle, NSW, 2305, Australia
| | - Craig E Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Justine Daly
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Longworth Avenue, Locked Bag 10, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Desmet C, Reynolds R, Hollis J, Licata M, Daly J, Doherty E, Tully B, Lecathelinais C, Wiggers J, Kingsland M. Clustering of smoking, alcohol consumption and weight gain in pregnancy: prevalence, care preferences and associated factors. BMC Pregnancy Childbirth 2023; 23:799. [PMID: 37978464 PMCID: PMC10655328 DOI: 10.1186/s12884-023-06090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Smoking, alcohol consumption and weight gain outside recommendations during pregnancy are preventable health risk factors associated with poorer health outcomes for mother and infant. Clustering of these risk factors further increases the risk and severity of outcomes. Limited research has explored the characteristics of pregnant women that are associated with clustering of these risks and women's preferences for receiving support. This paper aimed to determine: (i) the prevalence of clustered preventable risk factors; (ii) associations between maternal characteristics and presence of clustered risk factors; and (iii) women's preferences for receiving care for clustered risk factors. METHODS A cross-sectional survey was undertaken with women who had recently given birth in public maternity services in New South Wales, Australia. Descriptive statistics were used to assess prevalence of clustered risk factors and care preferences. Associations between the presence of clustered risk factors and maternal characteristics were assessed using multiple regression analyses. RESULTS Of the 514 women who completed the survey, 52% reported one preventable health risk factor and 10% and 2% reported two or three. For women with two or more risk factors, the most common combination was alcohol consumption and gestational weight gain outside of recommendations (50%, n = 30). One characteristic had an association with the presence of clustered risk factors. Most women (77%, n = 46) with clustered risk factors indicated they wanted support for these health risks. Preferences for support addressing some or all risk factors, and whether the support was sequential or simultaneous, were not associated with particular risk factor combinations. CONCLUSIONS Around one in eight women reported clustered preventable risk factors during pregnancy, most of whom would like support to address these risks. There was only one association between maternal characteristics and clustered risk factors. This suggests a need for antenatal care that is women-centred and caters for a diverse profile of clustered risks and varied preferences for care.
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Affiliation(s)
- Clare Desmet
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Renee Reynolds
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Jenna Hollis
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Milly Licata
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia.
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Justine Daly
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Belinda Tully
- Armajun Aboriginal Health Service, Inverell, NSW, 2360, Australia
- Gomeroi Nation, Inverell, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia
- Population Health Research Group, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, 2308, Australia
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Nathan N, Hall A, Shoesmith A, Bauman AE, Peden B, Duggan B, Gardner C, Lane C, Lecathelinais C, Oldmeadow C, Duncan C, Groombridge D, Riley-Gibson E, Pollock E, Boyer J, Wiggers J, Gillham K, Pattinson M, Mattingly M, McCarthy N, Naylor PJ, Reeves P, Budgen P, Sutherland R, Jackson R, Croft T, Pascoe W, Wolfenden L. A cluster randomised controlled trial to assess the effectiveness of a multi-strategy sustainability intervention on teachers' sustained implementation of classroom physical activity breaks (energisers): study protocol. BMC Public Health 2023; 23:1942. [PMID: 37805480 PMCID: PMC10559446 DOI: 10.1186/s12889-023-16810-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/21/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers' sustainment of energisers (short 3-5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up. METHODS A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods. DISCUSSION This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools' sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally. TRIAL REGISTRATION ACTRN12620000372987 version 1 registered 17th March 2020. Version 3 (current version) updated 4th August 2023.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Alix Hall
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Adam Shoesmith
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
- Hunter New England Population Health, Hunter New England Local Health District, Locked Bag No. 10, Wallsend, NSW 2287 Australia
| | - Adrian E. Bauman
- Prevention Research Collaboration, Sydney School of Public Health, Sydney, Australia
- Charles Perkins Centre (D17), The University of Sydney, Sydney, NSW 2006 Australia
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW Australia
| | - Belinda Peden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
| | - Bernadette Duggan
- Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, NSW Australia
| | - Carly Gardner
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Cassandra Lane
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | | | - Craig Duncan
- Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, NSW Australia
| | - Daniel Groombridge
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Edward Riley-Gibson
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Emma Pollock
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - James Boyer
- The NSW Department of Education, Sydney, NSW Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Martina Pattinson
- Health Promotion, Northern NSW Local Health District, Lismore, NSW Australia
| | - Megan Mattingly
- Health Promotion, Murrumbidgee Local Health District, Suite 1B/620 Macauley Street, Albury, NSW 2640 Australia
| | - Nicole McCarthy
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC Canada
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Philippa Budgen
- Health Promotion Service, Illawarra Shoalhaven Local Health District, NSW Health, Warrawong, NSW Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Rebecca Jackson
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
| | - Thomas Croft
- Aboriginal Health Unit, Hunter New England Local Health District, Wallsend, NSW Australia
| | - William Pascoe
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
- National Centre of Implementation Science, Hunter New England Area Health Service, Newcastle, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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Hall A, Lane C, Wolfenden L, Wiggers J, Sutherland R, McCarthy N, Jackson R, Shoesmith A, Lecathelinais C, Reeves P, Bauman A, Gillham K, Boyer J, Naylor PJ, Kerr N, Kajons N, Nathan N. Evaluating the scaling up of an effective implementation intervention (PACE) to increase the delivery of a mandatory physical activity policy in primary schools. Int J Behav Nutr Phys Act 2023; 20:106. [PMID: 37674213 PMCID: PMC10481546 DOI: 10.1186/s12966-023-01498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 08/01/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Physically Active Children in Education (PACE) is an effective implementation intervention for increasing the number of minutes classroom teachers schedule physical activity each week. To date, evaluations of PACE have included a smaller number of schools from only one region in New South Wales Australia. If PACE is to have population-wide benefits we must be able to deliver this support to a larger number of schools across multiple regions. This study aimed to evaluate the scale-up of PACE. METHODS An uncontrolled before and after study, with 100 schools from three regions was conducted. Participating schools received PACE for approximately 12 months. We assessed the following outcomes: delivery of the evidence-based intervention (EBI) (i.e. minutes of physical activity scheduled by classroom teachers per week); delivery of the implementation strategies (i.e. reach, dose delivered, adherence and indicators of sustainability); and key determinants of implementation (i.e. acceptability of strategies and cost). Data were collected via project officer records, and principal and teacher surveys. Linear mixed models were used to assess EBI delivery by evaluating the difference in the mean minutes teachers scheduled physical activity per week from baseline to follow-up. Descriptive data were used to assess delivery of the implementation strategies and their perceived acceptability (i.e. PACE). A prospective, trial-based economic evaluation was used to assess cost. RESULTS Delivery of the EBI was successful: teachers increas their average minutes of total physical activity scheduled across the school week by 26.8 min (95% CI: 21.2, 32.4, p < 0.001) after receiving PACE. Indicators for delivery of implementation strategies were high: 90% of consenting schools received all strategies and components (reach); 100% of strategies were delivered by the provider (dose); >50% of schools adhered to the majority of strategies (11 of the 14 components); and acceptability was > 50% agreement for all strategies. The incremental cost per additional minute of physical activity scheduled per week was $27 per school (Uncertainty Interval $24, $31). CONCLUSIONS PACE can be successfully delivered across multiple regions and to a large number of schools. Given the ongoing and scalable benefits of PACE, it is important that we continue to extend and improve this program while considering ways to reduce the associated cost.
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Affiliation(s)
- Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia.
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia.
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Nicole McCarthy
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Rebecca Jackson
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Adrian Bauman
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Karen Gillham
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
| | - James Boyer
- School Sport Unit, NSW Department of Education, Turrella, NSW, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Nicola Kerr
- Health Promotion, Mid North Coast Local Health District, Coffs Harbour, Australia
| | - Nicole Kajons
- Health Promotion and Population Health Improvement, Central Coast Local Health District, Gosford, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, NSW, 2287, Newcastle, Australia
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, NSW, Australia
- National Centre of Implementation Science, The University of Newcastle, Newcastle, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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6
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Marsden DL, Boyle K, Birnie J, Buzio A, Dizon J, Dunne J, Greensill S, Hill K, Lever S, Minett F, Ormond S, Shipp J, Steel J, Styles A, Wiggers J, Cadilhac DAM, Duff J. Improving Practice for Urinary Continence Care on Adult Acute Medical and Rehabilitation Wards: A Multi-Site, Co-Created Implementation Study. Healthcare (Basel) 2023; 11:healthcare11091241. [PMID: 37174783 PMCID: PMC10178438 DOI: 10.3390/healthcare11091241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Many adult inpatients experience urinary continence issues; however, we lack evidence on effective interventions for inpatient continence care. We conducted a before and after implementation study. We implemented our guideline-based intervention using strategies targeting identified barriers and evaluated the impact on urinary continence care provided by inpatient clinicians. Fifteen wards (acute = 3, rehabilitation = 7, acute and rehabilitation = 5) at 12 hospitals (metropolitan = 4, regional = 8) participated. We screened 2298 consecutive adult medical records for evidence of urinary continence symptoms over three 3-month periods: before implementation (T0: n = 849), after the 6-month implementation period (T1: n = 740), and after a 6-month maintenance period (T2: n = 709). The records of symptomatic inpatients were audited for continence assessment, diagnosis, and management plans. All wards contributed data at T0, and 11/15 wards contributed at T1 and T2 (dropouts due to COVID-19). Approximately 26% of stroke, 33% acute medical, and 50% of rehabilitation inpatients were symptomatic. The proportions of symptomatic patients (T0: n = 283, T1: n = 241, T2: n = 256) receiving recommended care were: assessment T0 = 38%, T1 = 63%, T2 = 68%; diagnosis T0 = 30%, T1 = 70%, T2 = 71%; management plan T0 = 7%, T1 = 24%, T2 = 24%. Overall, there were 4-fold increased odds for receiving assessments and management plans and 6-fold greater odds for diagnosis. These improvements were sustained at T2. This intervention has improved inpatient continence care.
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Affiliation(s)
- Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Belmont Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jaclyn Birnie
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
| | - Amanda Buzio
- Coffs Harbour Health Campus, Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Joshua Dizon
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Judith Dunne
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Sandra Greensill
- Rockhampton Hospital, Central Queensland Hospital and Health Service, Rockhampton, QLD 4700, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, VIC 3000, Australia
| | - Sandra Lever
- Ryde Hospital, Northern Sydney Local Health District, Eastwood, NSW 2122, Australia
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW 2006, Australia
| | - Fiona Minett
- Manning Hospital, Hunter New England Local Health District, Taree, NSW 2430, Australia
- Wingham Hospital, Hunter New England Local Health District, Wingham, NSW 2429, Australia
| | - Sally Ormond
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- Calvary Mater Newcastle, Waratah, NSW 2298, Australia
| | - Jodi Shipp
- Rankin Park Centre, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
- John Hunter Hospital, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Jennifer Steel
- Port Macquarie Hospital, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia
| | - Amanda Styles
- Armidale Hospital, Hunter New England Local Health District, Armidale, NSW 2350, Australia
- Tamworth Hospital, Hunter New England Local Health District, Tamworth, NSW 2340, Australia
| | - John Wiggers
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Health Research and Translation, Hunter New England Local Health District, New Lambton Heights, NSW 2305, Australia
| | - Dominique Ann-Michele Cadilhac
- Stroke and Ageing Research, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Clayton, VIC 3168, Australia
| | - Jed Duff
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4001, Australia
- Royal Brisbane and Womens Hospital, Queensland Health, Brisbane, QLD 4029, Australia
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7
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Wynne O, Szewczyk Z, Hollis J, Farragher E, Doherty E, Tully B, Paolucci F, Gillham K, Reeves P, Wiggers J, Kingsland M. Study protocol for an economic evaluation and budget impact of implementation strategies to support routine provision of antenatal care for gestational weight gain: a stepped-wedge cluster trial. Implement Sci Commun 2023; 4:40. [PMID: 37072809 PMCID: PMC10114337 DOI: 10.1186/s43058-023-00420-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antenatal clinical practice guidelines recommend routine assessment of weight and provision of advice on recommended weight gain during pregnancy and referral to additional services when appropriate. However, there are barriers to clinicians adopting such best-practice guidelines. Effective, cost-effective, and affordable implementation strategies are needed to ensure the intended benefits of guidelines are realised. This paper describes the protocol for evaluating the efficiency and affordability of implementation strategies compared to the usual practice in public antenatal services. METHOD The prospective trial-based economic evaluation will identify, measure, and value key resource and outcome impacts arising from the implementation strategies compared with usual practice. The evaluation will comprise of (i) costing, (ii) cost-consequence analyses, where a scorecard approach will be used to show the costs and benefits given the multiple primary outcomes included in the trial, and (iii) cost-effectiveness analysis, where the primary outcome will be incremental cost per percent increase in participants reporting receipt of antenatal care for gestational weight gain consistent with the guideline recommendations. Affordability will be evaluated using (iv) budget impact assessment and will estimate the financial implications of adoption and diffusion of this implementation strategy from the perspective of relevant fund-holders. DISCUSSION Together with the findings from the effectiveness trial, the outcomes of this economic evaluation will inform future healthcare policy, investment allocation, and research regarding the implementation of antenatal care to support healthy gestational weight gain. TRIAL REGISTRATION Trial Registration: Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819 (22/01/2021) http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380680&isReview=true .
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Affiliation(s)
- Olivia Wynne
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia.
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Zoe Szewczyk
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jenna Hollis
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Eva Farragher
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- , Tamworth, Australia
| | - Francesco Paolucci
- College of Human and Social Futures, Newcastle Business School, University of Newcastle, Callaghan, NSW, Australia
- Department of Sociology and Business Law, School of Economics and Statistics, University of Bologna, Bologna, Italy
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Penny Reeves
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, NSW, 2287, Australia
- School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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8
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Yoong SL, Bolsewicz K, Reilly K, Williams C, Wolfenden L, Grady A, Kingsland M, Finch M, Wiggers J. Describing the evidence-base for research engagement by health care providers and health care organisations: a scoping review. BMC Health Serv Res 2023; 23:75. [PMID: 36694193 PMCID: PMC9872336 DOI: 10.1186/s12913-022-08887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/24/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research. OBJECTIVES This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies. METHODS A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a 'deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research'. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement. RESULTS A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity. CONCLUSIONS The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.
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Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Burwood, VIC 3125 Australia ,Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Katarzyna Bolsewicz
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.493834.1National Centre for Immunisation Research and Surveillance, Sydney Children’s Hospital Network, Sydney, NSW 2145 Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Christopher Williams
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - Meghan Finch
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308 Australia ,grid.413648.cHunter Medical Research Institute, Newcastle, NSW 2300 Australia ,grid.266842.c0000 0000 8831 109XPriority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308 Australia
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9
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Reynolds R, Kingsland M, Daly J, Licata M, Tully B, Doherty E, Farragher E, Desmet C, Lecathelinais C, McKie J, Williams M, Wiggers J, Hollis J. Breastfeeding practices and associations with pregnancy, maternal and infant characteristics in Australia: a cross-sectional study. Int Breastfeed J 2023; 18:8. [PMID: 36658629 PMCID: PMC9854140 DOI: 10.1186/s13006-023-00545-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/10/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Exclusive breastfeeding to six months of age is a major global public health priority. Several characteristics are known to be associated with early cessation of breastfeeding, however, limited evidence exists regarding whether women's reported reasons for cessation are associated with maternal, pregnancy and infant characteristics. The aims of this study were to: i) describe women's reported intention to breastfeed and their subsequent breastfeeding practices; ii) describe women's reported reasons for breastfeeding cessation prior to the infant being five months of age; and iii) examine associations between these factors and maternal, pregnancy and infant characteristics. METHODS Telephone and online surveys were conducted between October 2019 and April 2020 with 536 women who had given birth in the previous eight to 21 weeks at four public maternity services in Australia. RESULTS The majority of women intended to (94%), and did, initiate (95%) breastfeeding. At the time the survey was conducted, 57% of women were exclusively breastfeeding. Women who: had less than University level education, had a pre-pregnancy BMI in the overweight or obese category, and who smoked tobacco at the time of the survey had lower odds of exclusively breastfeeding. The most common self-reported reasons for breastfeeding cessation were breastfeeding challenges (47%) and low milk supply (40%). Women aged 26-35 years and 36 + years had greater odds of reporting breastfeeding cessation due to low milk supply (OR = 2.92, 95% CI: 1.11, 7.66; OR = 5.57, 95% CI: 1.70, 18.29) compared to women aged 18-25 years. While women who had completed a TAFE certificate or diploma had lower odds of reporting this as a reason for breastfeeding cessation (OR = 0.28; 95% CI: 0.11, 0.73) compared to women who had University level education. There were no other significant associations found between characteristics and reasons for ceasing breastfeeding. CONCLUSIONS The most common reasons for breastfeeding cessation may be modifiable through the provision of breastfeeding support in the early postpartum period, with such support being tailored to women's age and level of education. Such support should aim to increase women's self-efficacy in breastfeeding, and be provided from the antenatal period and throughout the first six months postpartum.
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Affiliation(s)
- Renee Reynolds
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Melanie Kingsland
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Justine Daly
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Milly Licata
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Belinda Tully
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,Gomeroi Nation, NSW Australia
| | - Emma Doherty
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Eva Farragher
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Clare Desmet
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Christophe Lecathelinais
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Julianne McKie
- grid.3006.50000 0004 0438 2042Maternity Services, Hunter New England Local Health District, New Lambton Heights, NSW Australia
| | - Melanie Williams
- grid.3006.50000 0004 0438 2042Maternity Services, Hunter New England Local Health District, Armidale, NSW Australia
| | - John Wiggers
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Jenna Hollis
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
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10
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Doherty E, Wiggers J, Wolfenden L, Tully B, Lecathelinais C, Attia J, Elliott EJ, Dunlop A, Symonds I, Rissel C, Tsang TW, Kingsland M. Differential effectiveness of a practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: Exploratory subgroup analyses within a randomised stepped-wedge controlled trial. Midwifery 2023; 116:103528. [PMID: 36334528 DOI: 10.1016/j.midw.2022.103528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A practice change intervention demonstrated improvements in the provision of antenatal care addressing alcohol consumption. The aim of this study was to explore whether the effectiveness of the intervention differed between subgroups of pregnant women and types and location of maternity services. DESIGN AND SETTING Post-hoc exploratory subgroup analyses of the outcomes from a randomised stepped-wedge controlled trial conducted with all public maternity services within three sectors of a local health district in Australia. MEASUREMENTS Two outcomes (receipt of alcohol assessment and complete care) measured at two visit types (initial and subsequent) were included in analyses. Logistic regression models explored interactions between pre-post differences and subgroups of women (age, Aboriginal origin, education level, disadvantage, gravidity and alcohol consumption in pregnancy) and services (geographic remoteness, service and provider type/s) that have been reported to be associated with variation in guideline implementation. FINDINGS Surveys from 5694 women were included in the analyses. For the initial visit, no significant differential intervention effects between subgroups of women or type/location of services were found for either outcome. For subsequent visits, the intervention effect differed significantly only between Aboriginal origin subgroups (Aboriginal OR: 1.95; 95% CI: 0.99-3.85; non-Aboriginal OR: 5.34; 95% CI: 4.17-6.83; p<0.01) and women's alcohol consumption in pregnancy subgroups (consumed alcohol OR: 1.28; 95% CI: 0.59-2.78; not consumed alcohol OR: 5.22; 95% CI: 4.11-6.65; p<0.001) for assessment of alcohol consumption. KEY CONCLUSIONS These exploratory results suggest that the intervention may have had similar effects between different subgroups of women and types and location of services, with the exception of women who were non-Aboriginal and women who had not consumed alcohol, for whom the intervention was potentially more effective. IMPLICATIONS FOR PRACTICE The practice change intervention could be implemented with different maternity service and provider types to effectively support improvements in antenatal care addressing alcohol consumption. These exploratory results provide further data for hypothesis generation regarding targeted areas for the testing of additional strategies that enable Aboriginal women to benefit equally from the intervention, and to ensure those women most in need of care, those consuming alcohol during pregnancy, have their care needs met.
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia.
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia; Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia 5005, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory 0909, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, New South Wales 2006, Australia; Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales 2145, Australia
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales 2287, Australia; School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, New South Wales 2305, Australia
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11
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Doherty E, Kingsland M, Wiggers J, Wolfenden L, Hall A, McCrabb S, Tremain D, Hollis J, Licata M, Wynne O, Dilworth S, Daly JB, Tully B, Dray J, Bailey KA, Elliott EJ, Hodder RK. The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review. Implement Sci Commun 2022; 3:121. [PMID: 36419177 PMCID: PMC9682815 DOI: 10.1186/s43058-022-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption. METHODS A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date. CONCLUSIONS Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care. TRIAL REGISTRATION PROSPERO-CRD42019131691.
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Affiliation(s)
- Emma Doherty
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Melanie Kingsland
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Luke Wolfenden
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Alix Hall
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sam McCrabb
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Danika Tremain
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Jenna Hollis
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Milly Licata
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sophie Dilworth
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Justine B. Daly
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Belinda Tully
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Kylie A. Bailey
- grid.266842.c0000 0000 8831 109XSchool of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW Australia
| | - Elizabeth J. Elliott
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006 Australia ,grid.413973.b0000 0000 9690 854XSydney Children’s Hospital Network, Kids’ Research Institute, Westmead, NSW 2145 Australia
| | - Rebecca K. Hodder
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
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12
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Dempsey K, Ferguson C, Walczak A, Middleton S, Levi C, Morton RL, Boydell K, Campbell M, Cass A, Duff J, Elliott C, Geelhoed G, Jones A, Keech W, Leone V, Liew D, Linedale E, Mackinolty C, McFayden L, Norris S, Skouteris H, Story D, Tucker R, Wakerman J, Wallis L, Waterhouse T, Wiggers J. Which strategies support the effective use of clinical practice guidelines and clinical quality registry data to inform health service delivery? A systematic review. Syst Rev 2022; 11:237. [PMID: 36352475 PMCID: PMC9644489 DOI: 10.1186/s13643-022-02104-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Empirical evidence suggests data and insights from the clinical practice guidelines and clinical quality registries are not being fully utilised, leaving health service managers, clinicians and providers without clear guidance on how best to improve healthcare delivery. This lack of uptake of existing research knowledge represents low value to the healthcare system and needs to change. METHODS Five electronic databases (MEDLINE, Embase, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews) were systematically searched. Included studies were published between 2000 and 2020 reporting on the attributes, evidence usage and impact of clinical practice guidelines and clinical quality registries on health service delivery. RESULTS Twenty-six articles including one randomised controlled trial, eight before-and-after studies, eight case studies/reviews, five surveys and four interview studies, covering a wide range of medical conditions and conducted in the USA, Australia and Europe, were identified. Five complementary strategies were derived to maximise the likelihood of best practice health service delivery: (1) feedback and transparency, (2) intervention sustainability, (3) clinical practice guideline adherence, (4) productive partnerships and (5) whole-of-team approach. CONCLUSION These five strategies, used in context-relevant combinations, are most likely to support the application of existing high-quality data, adding value to health service delivery. The review highlighted the limitations of study design in opportunistic registry studies that do not produce clear, usable evidence to guide changes to health service implementation practices. Recommendations include exploration of innovative methodologies, improved coordination of national registries and the use of incentives to encourage guideline adherence and wider dissemination of strategies used by successful registries.
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Affiliation(s)
- Kathy Dempsey
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia.
| | | | - Adam Walczak
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of NSW, Kensington, Australia
| | - Sandy Middleton
- Nursing Research Unit, Australian Catholic University, Sydney, Australia
| | - Christopher Levi
- Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), University of NSW, Kensington, Australia
| | - Rachael L Morton
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
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Tsang TW, Kingsland M, Doherty E, Wiggers J, Attia J, Wolfenden L, Dunlop A, Tully B, Symonds I, Rissel C, Lecathelinais C, Elliott EJ. Effectiveness of a practice change intervention in reducing alcohol consumption in pregnant women attending public maternity services. Subst Abuse Treat Prev Policy 2022; 17:63. [PMID: 36045392 PMCID: PMC9429389 DOI: 10.1186/s13011-022-00490-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background The aim of this study was to examine the effect of a practice change intervention to support the implementation of guideline-recommended care for addressing alcohol use in pregnancy on self-reported alcohol use during pregnancy. Methods A randomized, stepped-wedge controlled trial in three clusters (sectors) within the Hunter New England Local Health District (NSW, Australia). We evaluated a practice change intervention that supported the introduction of a new model of care for reducing alcohol use in pregnancy, consistent with local and international guidelines, and implemented in random order across the sectors. Each week throughout the study period, pregnant women who attended any public antenatal services within the previous week, for a 27–28 or 35–36 week gestation visit, were randomly sampled and invited to participate in the survey. The intended intervention for all women was Brief advice (to abstain from alcohol and information about potential risks). Women identified as medium-risk alcohol consumers using the Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) were to be offered referral to a phone coaching service, and women identified as high-risk were to be offered referral to a Drug and Alcohol Service. Rates of self-reported alcohol use (AUDIT-C risk level and special occasion drinking) were summarized and compared in groups of women pre-intervention and post-intervention using multivariable logistic regression. Results Surveys were completed by 1309 women at pre-intervention and 2540 at post-intervention. The majority of women did not drink during pregnancy (pre-intervention: 89.68%; post-intervention: 90.74%). There was no change in the proportion of women classified as No risk from drinking (AUDIT-C score = 0) or Some risk from drinking (AUDIT-C score ≥ 1) pre- or post-intervention (p = 0.08). However, a significant reduction in special occasion drinking was observed (pre-intervention: 11.59%; post-intervention: 8.43%; p < 0.001). Conclusions Special occasion drinking was reduced following implementation of guideline-recommended care. Failure to change other patterns of alcohol use in pregnancy may reflect barriers to implementing the model of care in antenatal care settings and the need to address other social determinants of alcohol use. Trial registration Australian and New Zealand Clinical Trials Registry (registration number: ACTRN12617000882325; date: 16 June 2017).
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14
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Doherty E, Wiggers J, Nathan N, Hall A, Wolfenden L, Tully B, Elliott EJ, Attia J, Dunlop AJ, Symonds I, Tsang TW, Reeves P, McFadyen T, Wynne O, Kingsland M. Iterative delivery of an implementation support package to increase and sustain the routine provision of antenatal care addressing alcohol consumption during pregnancy: study protocol for a stepped-wedge cluster trial. BMJ Open 2022; 12:e063486. [PMID: 35882461 PMCID: PMC9330336 DOI: 10.1136/bmjopen-2022-063486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 07/14/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antenatal care addressing alcohol consumption during pregnancy is not routinely delivered in maternity services. Although a number of implementation trials have reported significant increases in such care, the majority of women still did not receive all recommended care elements, and improvements dissipated over time. This study aims to assess the effectiveness of an iteratively developed and delivered implementation support package in: (1) increasing the proportion of pregnant women who receive antenatal care addressing alcohol consumption and (2) sustaining the rate of care over time. METHODS AND ANALYSIS A stepped-wedge cluster trial will be conducted as a second phase of a previous trial. All public maternity services within three sectors of a local health district in Australia will receive an implementation support package that was developed based on an assessment of outcomes and learnings following the initial trial. The package will consist of evidence-based strategies to support increases in care provision (remind clinicians; facilitation; conduct educational meetings) and sustainment (develop a formal implementation blueprint; purposely re-examine the implementation; conduct ongoing training). Measurement of outcomes will occur via surveys with women who attend antenatal appointments each week. Primary outcomes will be the proportion of women who report being asked about alcohol consumption at subsequent antenatal appointments; and receiving complete care (advice and referral) relative to alcohol risk at initial and subsequent antenatal appointments. Economic and process evaluation measures will also be reported. ETHICS AND DISSEMINATION Ethical approval was obtained through the Hunter New England (16/11/16/4.07, 16/10/19/5.15) and University of Newcastle Human Research Ethics Committees (H-2017-0032, H-2016-0422) and the Aboriginal Health and Medical Research Council (1236/16). Trial findings will be disseminated to health service decision makers to inform the feasibility of conducting additional cycles to further improve antenatal care addressing alcohol consumption as well as at scientific conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry (ACTRN12622000295741).
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Affiliation(s)
- Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Clinical Research Design and Statistics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Adrian John Dunlop
- Drug and Alcohol Clinical Services Research, Hunter New England Local Health District, New Lambton, New South Wales, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, Australia
| | - Penny Reeves
- Health Research Economics, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Tameka McFadyen
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- Thurru Indigenous Health Unit, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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15
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Tsang TW, Kingsland M, Doherty E, Anderson AE, Tully B, Ward S, Wiggers J, Elliott EJ. Written information and health professionals are the information sources about alcohol use in pregnancy most often used by pregnant women. Drug Alcohol Rev 2022; 41:1599-1609. [PMID: 35836339 DOI: 10.1111/dar.13512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Alcohol use in pregnancy remains common in Australia, despite national guidelines recommending that pregnant women abstain. The aims of this study were to investigate where pregnant women obtain information about alcohol use in pregnancy and the relationship between the information source used and women's demographic characteristics and alcohol use. METHODS In this cross-sectional survey of pregnant women attending public maternity services in the Hunter New England region (New South Wales), women were asked, 'Where did you get information to help you make decisions about alcohol use during pregnancy?'. The number and types of information sources were analysed using descriptive statistics. Associations between women's information sources, and their demographic characteristics and alcohol use in pregnancy were assessed using chi-square tests and logistic regression. RESULTS Of 4511 pregnant women surveyed, 80.1% used at least one type of information source (range 0-5). Written/electronic information (45.4%), health providers (37.6%) and family/friends (19.5%) were the sources most reported. Higher use of written/electronic information, antenatal health providers and family/friends was associated with first pregnancy, younger age and higher education. The type of information source used was associated with alcohol use in pregnancy. Women who reported alcohol use were more likely to receive information from written/electronic sources. Almost 20% of women (older, multiparous [>1 pregnancy] and more highly educated) obtained no information regarding alcohol use in pregnancy. DISCUSSION AND CONCLUSIONS Antenatal providers should routinely provide information on alcohol use in pregnancy, including for women least likely to access available information.
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Affiliation(s)
- Tracey W Tsang
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Canberra, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, Australia.,Sydney Children's Hospitals Network, Kids Research, Sydney, Australia
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16
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Dee F, Savage L, Leitch JW, Collins N, Loten C, Fletcher P, French J, Weaver N, Watson O, Orvad H, Inder KJ, McIvor D, Williams T, Davies AJ, Attia J, Wiggers J, Sverdlov AL, Boyle AJ. Management of Acute Coronary Syndromes in Patients in Rural Australia: The MORACS Randomized Clinical Trial. JAMA Cardiol 2022; 7:690-698. [PMID: 35612860 PMCID: PMC10881213 DOI: 10.1001/jamacardio.2022.1188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/16/2022] [Indexed: 12/12/2022]
Abstract
Importance Treatment of ST-segment elevation myocardial infarction (STEMI) in rural settings involves thrombolysis followed by transfer to a percutaneous coronary intervention-capable hospital. The first step is accurate diagnosis via electrocardiography (ECG), but one-third of all STEMI incidents go unrecognized and hence untreated. Objective To reduce missed diagnoses of STEMI. Design, Setting, and Participants This cluster randomized clinical trial included 29 hospital emergency departments (EDs) in rural Australia with no emergency medicine specialists, which were randomized to usual care vs automatically triggered diagnostic support from the tertiary referral hospital (management of rural acute coronary syndromes [MORACS] intervention). Patients presenting with symptoms compatible with acute coronary syndromes (ACS) were eligible for inclusion. The study was conducted from December 2018 to April 2020. Data were analyzed in August 2021. Intervention Triage of a patient with symptoms compatible with ACS triggered an automated notification to the tertiary hospital coronary care unit. The ECG and point-of-care troponin results were reviewed remotely and a phone call was made to the treating physician in the rural hospital to assist with diagnosis and initiation of treatment. Main Outcomes and Measures The proportion of patients with missed STEMI diagnoses. Results A total of 6249 patients were included in the study (mean [SD] age, 63.6 [12.2] years; 48% female). Of 7474 ED presentations with suspected ACS, STEMI accounted for 77 (2.0%) in usual care hospitals and 46 (1.3%) in MORACS hospitals. Missed diagnosis of STEMI occurred in 27 of 77 presentations (35%) in usual care hospitals and 0 of 46 (0%) in MORACS hospitals (P < .001). Of eligible patients, 48 of 75 (64%) in the usual care group and 36 of 36 (100%) in the MORACS group received primary reperfusion (P < .001). In the usual care group, 12-month mortality was 10.3% (n = 8) vs 6.5% (n = 3) in the MORACS group (relative risk, 0.64; 95% CI, 0.18-2.23). Patients with missed STEMI diagnoses had a mortality of 25.9% (n = 7) compared with 2.0% (n = 1) for those with accurately diagnosed STEMI (relative risk, 13.2; 95% CI, 1.71-102.00; P = .001). Overall, there were 6 patients who did not have STEMI as a final diagnosis; 5 had takotsubo cardiomyopathy and 1 had pericarditis. There was no difference between groups in the rate of alternative final diagnosis. Conclusion and Relevance The findings indicate that MORACS diagnostic support service reduced the proportion of missed STEMI and improved the rates of primary reperfusion therapy. Accurate diagnosis of STEMI was associated with lower mortality. Trial Registration anzctr.org.au Identifier: ACTRN12619000533190.
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Affiliation(s)
- Fiona Dee
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lindsay Savage
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - James W. Leitch
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nicholas Collins
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Conrad Loten
- John Hunter Hospital, Department of Emergency Medicine, Hunter New England Local Health District Newcastle, New South Wales, Australia
| | - Peter Fletcher
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John French
- Liverpool Hospital, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Olivia Watson
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Helen Orvad
- Tamworth Rural Referral Hospital, Hunter New England Local Health District Tamworth, New South Wales, Australia
| | - Kerry J. Inder
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Dawn McIvor
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
| | - Trent Williams
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Allan J. Davies
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John Attia
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- Population Health, Hunter New England Health Local Health District, Newcastle, New South Wales, Australia
| | - Aaron L. Sverdlov
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Andrew J. Boyle
- John Hunter Hospital, Department of Cardiovascular Medicine, Hunter New England Local Health District, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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17
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Attia JR, Holliday E, Weaver N, Peel R, Fleming KC, Hure A, Wiggers J, McEvoy M, Searles A, Reeves P, Ranasinghe P, Jayawardena R, Samman S, Luu J, Rissel C, Acharya S. The effect of zinc supplementation on glucose homeostasis: a randomised double-blind placebo-controlled trial. Acta Diabetol 2022; 59:965-975. [PMID: 35451678 PMCID: PMC9026040 DOI: 10.1007/s00592-022-01888-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/30/2022] [Indexed: 11/29/2022]
Abstract
AIMS The burden and health costs of Type 2 Diabetes Mellitus continue to increase globally and prevention strategies in at-risk people need to be explored. Previous work, in both animal models and humans, supports the role of zinc in improving glucose homeostasis. We, therefore, aimed to test the effectiveness of zinc supplementation on glycaemic control in pre-diabetic adults. METHODS We conducted a randomized, double-blind, placebo-controlled trial across 10 General Practitioner (GP) practices in NSW, Australia. The trial is known as Zinc in Preventing the Progression of pre-Diabetes (ZIPPeD)Study. Pre-diabetic (haemoglobin A1c [HbA1c] 5.7-6.4%, 39-46 mmol/mol) men and women (N = 98) were all assigned to a free state government telephone health coaching service (New South Wales Get Healthy Information and Coaching Service) and then randomised to either daily 30 mg zinc gluconate or placebo. Blood tests were collected at baseline, 1, 6 and 12 months for the primary outcomes (HbA1c, fasting blood glucose (FBG)); secondary outcomes included Homeostasis Model Assessment 2 (HOMA 2) parameters, lipids, body weight, height, waist circumference, blood pressure and pulse. RESULTS The baseline-adjusted mean group difference at 6 months, expressed as treatment-placebo, (95% CI) was -0.02 (-0.14, 0.11, p = 0.78) for HbA1c and 0.17 (-0.07, 0.42; p = 0.17) for FBG, neither of which were statistically significant. There were also no significant differences between groups in any of the secondary outcomes. Zinc was well tolerated, and compliance was high (88%). CONCLUSION We believe our results are consistent with other Western clinical trial studies and do not support the use of supplemental zinc in populations with a Western diet. There may still be a role for supplemental zinc in the developing world where diets may be zinc deficient. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12618001120268. Registered on 6 July 2018.
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Affiliation(s)
- John R Attia
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia.
- Division of Medicine, Hunter New England Local Health District, New Lambton Heights, Australia.
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
| | - Natasha Weaver
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
| | - Roseanne Peel
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
| | - Kerry C Fleming
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
| | - Alexis Hure
- Diabetes Service and Diabetes Alliance Hunter New England Local Health District, New Lambton Heights, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
- Hunter New England Local Health District, New Lambton Heights, Australia
| | - Mark McEvoy
- School of Medicine and Public Health, University of Newcastle, New Lambton Heights, Australia
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, VIC, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | | | - Samir Samman
- School of Life and Environmental Sciences, University of Sydney, New Lambton Heights, Australia
| | - Judy Luu
- Diabetes Stream, Diabetes Alliance HNELHD, New Lambton Heights, Australia
| | - Chris Rissel
- The University of Sydney, Camperdown, 2050, Australia
| | - Shamasunder Acharya
- Endocrinology and Diabetes Service and Diabetes Alliance Hunter New England Local Health District, New Lambton Heights, Australia
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18
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Wolfenden L, Hawe P, Rychetnik L, Sutherland R, Barnes C, Yoong S, Giles-Corti B, Mitchell J, Bauman A, Milat AJ, Chai LK, Mayfield S, Mastersson N, Freebairn L, Sacks G, Wilson A, Wright A, Wiggers J. A call to action: More collaborative implementation research is needed to prevent chronic disease. Aust N Z J Public Health 2022; 46:549-553. [PMID: 35735905 DOI: 10.1111/1753-6405.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales.,The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales
| | - Penelope Hawe
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Lucie Rychetnik
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
| | - Courtney Barnes
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales.,Faculty Health, Arts and Design, Swinburne University of Technology, Victoria
| | - Billie Giles-Corti
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Urban Research, RMIT University, Melbourne, Victoria
| | - Jo Mitchell
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Population Health, New South Wales Ministry of Health, Sydney, New South Wales
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Andrew J Milat
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, New South Wales
| | - Li Kheng Chai
- School of Exercise and Nutrition Science, Queensland University of Technology at the Centre for Children's Health Research (CCHR), South Brisbane, Queensland.,Health and Wellbeing Queensland, Queensland Government, Milton, Queensland
| | - Sara Mayfield
- Health and Wellbeing Queensland, Queensland Government, Milton, Queensland
| | - Nadia Mastersson
- The Commission on Excellence and Innovation in Health, Government of South Australia, Adelaide, South Australia
| | - Louise Freebairn
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Brain and Mind Centre, University of Sydney, Sydney, New South Wales
| | - Gary Sacks
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Deakin University, Global Obesity Centre, Institute for Health Transformation, Geelong, Victoria
| | - Andrew Wilson
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales.,Sydney School of Public Health, University of Sydney, Sydney, New South Wales
| | - Annemarie Wright
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria.,Victorian Health Promotion Foundation, Melbourne, Victoria
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New Lambton, New South Wales
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19
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Atorkey P, Paul C, Wiggers J, Bonevski B, Mitchell A, Tzelepis F. Intention to change multiple health risk behaviors and predictors of behavior change in vocational education students. J Am Coll Health 2022:1-9. [PMID: 35549632 DOI: 10.1080/07448481.2022.2068960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 03/24/2022] [Accepted: 04/18/2022] [Indexed: 06/15/2023]
Abstract
Objective: No studies have examined vocational education students' intention to change multiple health risk behaviors and whether baseline characteristics predict behavior change. Participants: Paticipants were vocational education students in New South Wales, Australia. Methods: Students in the no-intervention control arm of a cluster randomized controlled trial completed an online survey at baseline and 6 months later. Results: Of 450 participants (83.3%) who reported multiple health risk behaviors at baseline, one-third (33.1%) intended to change at least two risk behaviors within 6 months. Participants experiencing symptoms of anxiety [OR = 7.43, 95% CIs 1.26-43.87; p = 0.03] and who intended to change three to four risk behaviors [OR = 23.30, 95% CIs 4.01-135.40; p = 0.001] rather than one behavior had significantly greater odds of changing at least one behavior in 6 months. Conclusions: Interventions could support vocational education students to change behaviors they wish to as well as motivate them to address other risk behaviors.
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Affiliation(s)
- Prince Atorkey
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- Priority Research Centre for Health Behavior, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Christine Paul
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- Priority Research Centre for Health Behavior, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, Australia
- Priority Research Centre for Health Behavior, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, Australia
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20
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Doherty E, Kingsland M, Elliott EJ, Tully B, Wolfenden L, Dunlop A, Symonds I, Attia J, Ward S, Hunter M, Azzopardi C, Rissel C, Gillham K, Tsang TW, Reeves P, Wiggers J. Practice change intervention to improve antenatal care addressing alcohol consumption during pregnancy: a randomised stepped-wedge controlled trial. BMC Pregnancy Childbirth 2022; 22:345. [PMID: 35448996 PMCID: PMC9027411 DOI: 10.1186/s12884-022-04646-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/30/2022] [Indexed: 12/17/2022] Open
Abstract
Background Clinical guideline recommendations for addressing alcohol consumption during pregnancy are sub-optimally implemented and limited evidence exists to inform practice improvements. The aim of this study was to estimate the effectiveness of a practice change intervention in improving the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Methods A randomised stepped-wedge controlled trial was undertaken with all public maternity services in three sectors (one urban, two regional/rural) of a single local health district in New South Wales, Australia. All antenatal care providers were subject to a seven-month multi-strategy intervention to support the introduction of a recommended model of care. For 35 months (July 2017 – May 2020) outcome data were collected from randomly selected women post an initial, 27–28 weeks and 35–36 weeks gestation antenatal visit. Logistic regression models assessed intervention effectiveness. Results Five thousand six hundred ninety-four interviews/online questionnaires were completed by pregnant women. The intervention was effective in increasing women’s reported receipt of: assessment of alcohol consumption (OR: 2.63; 95% CI: 2.26–3.05; p < 0.001), advice not to consume alcohol during pregnancy and of potential risks (OR: 2.07; 95% CI: 1.78–2.41; p < 0.001), complete care relevant to alcohol risk level (advice and referral) (OR: 2.10; 95% CI: 1.80–2.44; p < 0.001) and all guideline elements relevant to alcohol risk level (assessment, advice and referral) (OR: 2.32; 95% CI: 1.94–2.76; p < 0.001). Greater intervention effects were found at the 27–28 and 35–36 weeks gestation visits compared with the initial antenatal visit. No differences by sector were found. Almost all women (98.8%) reported that the model of care was acceptable. Conclusions The practice change intervention improved the provision of antenatal care addressing alcohol consumption during pregnancy in public maternity services. Future research could explore the characteristics of pregnant women and maternity services associated with intervention effectiveness as well as the sustainment of care practices over time to inform the need for, and development of, further tailored practice change support. Trial registration Australian and New Zealand Clinical Trials Registry (Registration number: ACTRN12617000882325; Registration date: 16/06/2017) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372985&isReview=true
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Affiliation(s)
- Emma Doherty
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.
| | - Melanie Kingsland
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Elizabeth J Elliott
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Belinda Tully
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, 2302, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - Sarah Ward
- Foundation for Alcohol Research and Education, Deakin, Australian Capital Territory, 2600, Australia
| | - Mandy Hunter
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Carol Azzopardi
- Maternity and Gynaecology John Hunter Hospital, New Lambton Heights, New South Wales, 2305, Australia
| | - Chris Rissel
- College of Medicine and Public Health, Flinders University, Casuarina, Northern Territory, 0909, Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia
| | - Tracey W Tsang
- Faculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, 2006, Australia.,Sydney Children's Hospital Network, Kids' Research Institute, Westmead, New South Wales, 2145, Australia
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, New South Wales, 2287, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, 2305, Australia
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21
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Crane M, Nathan N, McKay H, Lee K, Wiggers J, Bauman A. Understanding the sustainment of population health programmes from a whole-of-system approach. Health Res Policy Syst 2022; 20:37. [PMID: 35392913 PMCID: PMC8988542 DOI: 10.1186/s12961-022-00843-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population health prevention programmes are needed to reduce the prevalence of chronic diseases. Nevertheless, sustaining programmes at a population level is challenging. Population health is highly influenced by social, economic and political environments and is vulnerable to these system-level changes. The aim of this research was to examine the factors and mechanisms contributing to the sustainment of population prevention programmes taking a systems thinking approach. METHODS We conducted a qualitative study through interviews with population health experts working within Australian government and non-government agencies experienced in sustaining public health programs at the local, state or national level (n = 13). We used a deductive thematic approach, grounded in systems thinking to analyse data. RESULTS We identified four key barriers affecting program sustainment: 1) short term political and funding cycles; 2) competing interests; 3) silo thinking within health service delivery; and 4) the fit of a program to population needs. To overcome these barriers various approaches have centred on the importance of long-range planning and resourcing, flexible program design and management, leadership and partnerships, evidence generation, and system support structures. CONCLUSION This study provides key insights for overcoming challenges to the sustainment of population health programmes amidst complex system-wide changes.
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Affiliation(s)
- Melanie Crane
- The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW, 2007, Australia.
- Sydney School of Public Health, the University of Sydney, Sydney, NSW, 2006, Australia.
- Prevention Research Collaboration, Charles Perkins Centre, the University of Sydney, Sydney, NSW, 2006, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Callaghan, NSW, Australia
| | - Heather McKay
- Department of Family Practice, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 123, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Centre, 2635 Laurel St, Vancouver, BC, V57 1M9, Canada
| | - Karen Lee
- The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW, 2007, Australia
- Sydney School of Public Health, the University of Sydney, Sydney, NSW, 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, the University of Sydney, Sydney, NSW, 2006, Australia
| | - John Wiggers
- The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW, 2007, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute (HMRI), New Lambton, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, 2308, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Callaghan, NSW, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, The Sax Institute, 235 Jones Street, Ultimo, NSW, 2007, Australia
- Sydney School of Public Health, the University of Sydney, Sydney, NSW, 2006, Australia
- Prevention Research Collaboration, Charles Perkins Centre, the University of Sydney, Sydney, NSW, 2006, Australia
- National Centre of Implementation Science (NCOIS), The University of Newcastle, Callaghan, NSW, Australia
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22
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Crooks K, Tully B, Allan L, Gillham K, Durrheim D, Wiggers J. Development and implementation of a shared governance model in a mainstream health unit: a case study of embedding Aboriginal voices in organisational decision making. AUST HEALTH REV 2022; 46:178-184. [PMID: 34937653 DOI: 10.1071/ah20369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 07/27/2021] [Indexed: 11/23/2022]
Abstract
This case study focuses on the development and implementation of a governance structure and processes by a mainstream health unit that valued the principles of Aboriginal self-determination, empowerment and leadership by Aboriginal staff in organisational and service delivery decisions and elevated Aboriginal voices by embedding cultural inclusion in such decision making. Various models of embedding Aboriginal voices in the governance of the unit were developed and implemented over time. Ongoing review and reflection identified limitations and opportunities for improving the embedding of Aboriginal voices in organisational decision making. In 2017, Aboriginal staff and senior management implemented a joint governance model for providing strategic leadership of the unit with the objective of enhancing the delivery of culturally appropriate population health services for the benefit of Aboriginal communities. In its 3 years of operation to date, the model has provided strategic oversight of the organisation, implemented several strategic initiatives, including a cultural assessment process, maintaining and strengthening Aboriginal recruitment, monitoring employment vacancies, establishing a wellbeing leadership group, monitoring budget allocation and developing an Aboriginal data management protocol, and has provided additional professional development opportunities for Aboriginal staff. This case study demonstrates the feasibility, importance and benefits of engaging and embedding Aboriginal voices in the governance of a mainstream health service delivery unit, as well as the need for ongoing reflection and improvement. Further translation of the model to the operational levels of the unit is required. The governance model has the potential to be replicated in a tailored manner in other mainstream health units and organisations delivering services to Aboriginal peoples and communities. What is known about the topic? Aboriginal people continue to experience the poorest health outcomes of any population group in Australia. Closing the gap in Aboriginal health requires Aboriginal people to be active and equal participants in all levels of decision making. Governance of mainstream health organisations is predominantly positioned in the Western medical positivist paradigm, which fails to embed Aboriginal voices in organisational and service delivery decision making. What does this paper add? This case study describes the processes taken and the outcomes achieved thus far by a mainstream health service delivery unit developing and implementing a governance model that embedded Aboriginal perspectives in its decision making. It highlights that through commitment and persistence, as well as acknowledging the challenges of working between two worlds, it is possible to reconstruct existing governance models, allowing respectful and meaningful space for Aboriginal people to co-design and co-share the governance of health service delivery. This case study demonstrates the potential of the cultural governance model to be replicated and applied to other mainstream health service delivery units. What are the implications for practitioners? This case study highlights the need for health services to invest in employing and empowering Aboriginal people to co-develop and co-lead a shared approach to organisational governance through processes that are culturally safe, inclusive and appropriate.
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Affiliation(s)
- K Crooks
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - B Tully
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - L Allan
- Office of the Secretary, NSW Department of Education, Tamworth, NSW, Australia
| | - K Gillham
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - D Durrheim
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
| | - J Wiggers
- Hunter New England Local Health District, Population Health, Wallsend, NSW, Australia
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23
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Yoong SL, Pearson N, Reilly K, Wolfenden L, Jones J, Nathan N, Okely A, Naylor PJ, Jackson J, Giles L, Imad N, Gillham K, Wiggers J, Reeves P, Highfield K, Lum M, Grady A. A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial. BMC Public Health 2022; 22:610. [PMID: 35351035 PMCID: PMC8961494 DOI: 10.1186/s12889-022-12883-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services. METHODS The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive 'usual' implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities. DISCUSSION Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN12621000987864 ). Prospectively registered 27th July 2021, ANZCTR - Registration.
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Affiliation(s)
- Sze Lin Yoong
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia.
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Nicole Pearson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kathryn Reilly
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jannah Jones
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Anthony Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia
- Illawarra Health and Medicine Research Institute, Wollongong, NSW, 2522, Australia
| | - Patti-Jean Naylor
- School of Exercise Science, Physical and Health Education, University of Victoria, Mackinnon 120, PO Box 1700, STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Jacklyn Jackson
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Luke Giles
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - Noor Imad
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, VIC, 3122, Australia
| | - Karen Gillham
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
| | - John Wiggers
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Penny Reeves
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | | | - Melanie Lum
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Alice Grady
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter New England Population Health, Wallsend, NSW, 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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Dray J, Licata M, Doherty E, Tully B, Williams B, Curtin S, White D, Lecathelinais C, Ward S, Hasson S, Elliott EJ, Wiggers J, Kingsland M. Enhancing clinician participation in quality improvement training: implementation and impact of an evidence-based initiative to maximise antenatal clinician participation in training regarding women’s alcohol consumption during pregnancy. BMC Health Serv Res 2022; 22:402. [PMID: 35351113 PMCID: PMC8962084 DOI: 10.1186/s12913-022-07717-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/23/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are significant challenges in ensuring sufficient clinician participation in quality improvement training. Clinician capability has been identified as a barrier to the delivery of evidence-based care. Clinician training is an effective strategy to address this barrier, however, there are significant challenges in ensuring adequate clinician participation in training. This study aimed to assess the extent of participation by antenatal clinicians in evidence-based training to address alcohol consumption during pregnancy, and to assess differences in participation by profession. Methods A 7-month training initiative based on six evidence-based principles was implemented in a maternity service in New South Wales, Australia. Descriptive statistics described participation in training (% attending: any training; six evidence-based principles of training; all principles). Regression analyses examined differences by profession. Results Almost all antenatal clinicians participated in some training (182/186; 98%); 69% participated in ≥1 h of training (μ = 88.2mins, SD:56.56). The proportion of clinicians participating in training that satisfied each of the six principles ranged from 35% (training from peers and experts) to 82% (training was educational and instructional). Only 7% participated in training that satisfied all principles. A significantly higher proportion of midwifery compared to medical clinicians participated in training satisfying five of the six training principles. Conclusions A training initiative based on evidence-based principles resulted in almost all clinicians receiving some training and 69% participating in at least 1 h of training. Variability between professions suggests training needs to be tailored to such groups. Further research is required to determine possible associations with care delivery outcomes. Trial registration Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017).
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Szewczyk Z, Reeves P, Kingsland M, Doherty E, Elliott E, Wolfenden L, Tsang TW, Dunlop A, Searles A, Wiggers J. Cost, cost-consequence and cost-effectiveness evaluation of a practice change intervention to increase routine provision of antenatal care addressing maternal alcohol consumption. Implement Sci 2022; 17:14. [PMID: 35120541 PMCID: PMC8815123 DOI: 10.1186/s13012-021-01180-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 12/07/2021] [Indexed: 12/20/2022] Open
Abstract
Background Implementation of antenatal clinical guideline recommendations for addressing maternal alcohol consumption is sub-optimal. There is a complete absence of evidence of the cost and cost-effectiveness of delivering practice change interventions addressing maternal alcohol consumption amongst women accessing maternity services. The study sought to determine the cost, cost-consequence and cost-effectiveness of developing and delivering a multi-strategy practice change intervention in three sectors of a health district in New South Wales, Australia. Methods The trial-based economic analyses compared the costs and outcomes of the intervention to usual care over the 35-month period of the stepped-wedge trial. A health service provider perspective was selected to focus on the cost of delivering the practice change intervention, rather than the cost of delivering antenatal care itself. All costs are reported in Australian dollars ($AUD, 2019). Univariate and probabilistic sensitivity analyses assessed the effect of variation in intervention effect and costs. Results The total cost of delivering the practice change intervention across all three sectors was $367,646, of which $40,871 (11%) were development costs and $326,774 (89%) were delivery costs. Labour costs comprised 70% of the total intervention delivery cost. A single practice change strategy, ‘educational meetings and educational materials’ contributed 65% of the delivery cost. Based on the trial’s primary efficacy outcome, the incremental cost effectiveness ratio was calculated to be $32,570 (95% CI: $32,566–$36,340) per percent increase in receipt of guideline recommended care. Based on the number of women attending the maternity services during the trial period, the average incremental cost per woman who received all guideline elements was $591 (Range: $329 - $940) . The average cost of the intervention per eligible clinician was $993 (Range: $640-$1928). Conclusion The intervention was more effective than usual care, at an increased cost. Healthcare funders’ willingness to pay for this incremental effect is unknown. However, the strategic investment in systems change is expected to improve the efficiency of the practice change intervention over time. Given the positive trial findings, further research and monitoring is required to assess the sustainability of intervention effectiveness and whether economies of scale, or reduced costs of intervention delivery can be achieved without impact on outcomes. Trial registration The trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry, No. ACTRN12617000882325 (date registered: 16/06/2017). Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01180-6.
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Affiliation(s)
- Zoe Szewczyk
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. .,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Penny Reeves
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Melanie Kingsland
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Emma Doherty
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Elizabeth Elliott
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids Research Institute, Westmead, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Tracey W Tsang
- School of Medicine, The University of Sydney, Camperdown, New South Wales, Australia.,Sydney Children's Hospital Network, Kids Research Institute, Westmead, New South Wales, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - John Wiggers
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
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26
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Hanly G, Campbell E, Bartlem K, Dray J, Fehily C, Bradley T, Murray S, Lecathelinais C, Wiggers J, Wolfenden L, Reid K, Reynolds T, Bowman J. Effectiveness of referral to a population-level telephone coaching service for improving health risk behaviours in people with a mental health condition: study protocol for a randomised controlled trial. Trials 2022; 23:49. [PMID: 35039058 PMCID: PMC8762844 DOI: 10.1186/s13063-021-05971-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition have a shorter life expectancy than the general population. This is largely attributable to higher rates of chronic disease and a higher prevalence of modifiable health risk behaviours including tobacco smoking, alcohol consumption, poor nutrition, and physical inactivity. Telephone support services offer a viable option to provide support to reduce these health risk behaviours at a population-level; however, whilst there is some research pertaining to Quitlines, there is limited other research investigating whether telephone services may offer effective support for people with a mental health condition. This protocol describes a randomised controlled trial that aims to evaluate the referral of people with a mental health condition to a population-level telephone coaching service to increase physical activity, healthy eating, or weight management, and increase attempts to do so. METHODS A parallel-group randomised controlled trial will be conducted recruiting participants with a mental health condition through community mental health services and advertisement on social media. Participants will be randomly assigned to receive either a health information pack only (control) or a health information pack and a proactive referral to a free, government-funded telephone coaching service, the NSW Get Healthy Coaching and Information Service® (intervention), which offers up to 13 telephone coaching calls with a University Qualified Health Coach to assist with client-identified goals relating to physical activity, healthy eating, weight management, or alcohol reduction. Data will be collected via telephone surveys at baseline and 6 months post-recruitment. Primary outcomes are as follows: (1) minutes of moderate to vigorous physical activity per week, (2) serves of fruit consumed per day, (3) serves of vegetables consumed per day, and (4) a composite measure assessing attempts to change at least one health risk behaviour (any attempts to change physical activity, fruit consumption, vegetable consumption, or other parts of nutrition). Secondary outcomes include weight and body mass index. DISCUSSION This study is the first to evaluate the effectiveness of referral to a population-level telephone support service for reducing health risk behaviours relating to physical activity, healthy eating, and weight in people with a mental health condition. Results will inform future policy and practice regarding the delivery of telephone-based behaviour change coaching services and the management of physical health for this population to reduce health inequity and the burden of chronic disease. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry ACTRN12620000351910 . Retrospectively registered on 12 March 2020.
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Affiliation(s)
- Grace Hanly
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Elizabeth Campbell
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Bartlem
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Julia Dray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Caitlin Fehily
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Tegan Bradley
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Sonya Murray
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
| | - Christophe Lecathelinais
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - John Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Luke Wolfenden
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Wallsend, NSW Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool, NSW Australia
| | | | - Jenny Bowman
- School of Psychological Sciences, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, Clinical Research Centre, New Lambton Heights, Australia
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
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27
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Hall A, Wolfenden L, Shoesmith A, McCarthy N, Wiggers J, Bauman AE, Rissel C, Sutherland R, Lecathelinais C, Brown H, Trost SG, Nathan N. The impact of an implementation intervention that increased school's delivery of a mandatory physical activity policy on student outcomes: A cluster-randomised controlled trial. J Sci Med Sport 2021; 25:321-326. [DOI: 10.1016/j.jsams.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/08/2021] [Accepted: 12/13/2021] [Indexed: 01/12/2023]
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Mclaughlin M, Campbell E, Sutherland R, McKenzie T, Davies L, Wiggers J, Wolfenden L. Extent, Type and Reasons for Adaptation and Modification When Scaling-Up an Effective Physical Activity Program: Physical Activity 4 Everyone (PA4E1). Front Health Serv 2021; 1:719194. [PMID: 37007208 PMCID: PMC10062321 DOI: 10.3389/frhs.2021.719194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/30/2021] [Indexed: 06/03/2023]
Abstract
Background: Few studies have described the extent, type and reasons for making changes to a program prior to and during its delivery using a consistent taxonomy. Physical Activity 4 Everyone (PA4E1) is a secondary school physical activity program that was scaled-up for delivery to a greater number of schools. We aimed to describe the extent, type and reasons for changes to the PA4E1 program (the evidence-based physical activity practices, implementation support strategies and evaluation methods) made before its delivery at scale (adaptations) and during its delivery in a scale-up trial (modifications). Methods: The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) was used to describe adaptations (planned and made prior to the scale-up trial) and modifications (made during the conduct of the trial). A list of adaptations was generated from a comparison of the efficacy and scale-up trials via published PA4E1 protocols, trial registrations and information provided by trial investigators. Monthly trial team meetings tracked and coded modifications in "real-time" during the conduct of the scale-up trial. The extent, type and reasons for both adaptations and modifications were summarized descriptively. Results: In total, 20 adaptations and 20 modifications were identified, these were to physical activity practices (n = 8; n = 3), implementation support strategies (n = 6; n = 16) and evaluation methods (n = 6, n = 1), respectively. Few adaptations were "fidelity inconsistent" (n = 2), made "unsystematically" (n = 1) and proposed to have a "negative" impact on the effectiveness of the program (n = 1). Reasons for the adaptations varied. Of the 20 modifications, all were "fidelity consistent" and the majority were made "proactively" (n = 12), though most were "unsystematic" (n = 18). Fifteen of the modifications were thought to have a "positive" impact on program effectiveness. The main reason for modification was the "available resources" (n = 14) of the PA4E1 Implementation Team. Conclusions: Adaptations and modifications to public health programs are common. Modifications have the potential to impact the implementation and effectiveness of programs. Our findings underscore the importance of comprehensive reporting of the extent, type and reasons for modifications as part of process evaluations, as this data may be important to the interpretation of trial findings. Clinical Trial Registration: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870, Identifier ACTRN12617000681358.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Lynda Davies
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
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Fleming K, Weaver N, Peel R, Hure A, McEvoy M, Holliday E, Parsons M, Acharya S, Luu J, Wiggers J, Rissel C, Ranasinghe P, Jayawardena R, Samman S, Attia J. Using the AUSDRISK score to screen for pre-diabetes and diabetes in GP practices: a case-finding approach. Aust N Z J Public Health 2021; 46:203-207. [PMID: 34762354 DOI: 10.1111/1753-6405.13181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To identify the optimal AUSDRISK threshold score to screen for pre-diabetes and diabetes. METHODS A total of 406 adult patients not diagnosed with diabetes were screened in General Practices (GP) between May and October 2019. All patients received a point of care (POC) HbA1c test. HbA1c test results were categorised into diabetes (≥6.5% or ≥48 mmol/mol), pre-diabetes (5.7-6.4% or 39-47 mmol/mol), or normal (<5.7% or 39 mmol/mol). RESULTS Of these patients, 9 (2%) had undiagnosed diabetes and 60 (15%) had pre-diabetes. A Receiver Operator Characteristic (ROC) curve was constructed to predict the presence of pre-diabetes and diabetes; the area under the ROC curve was 0.72 (95%CI 0.65-0.78) indicating modest predictive ability. The optimal threshold cut point for AUSDRISK score was 17 (sensitivity 76%, specificity 61%, + likelihood ratio (LR) 1.96, - likelihood ratio of 0.39) while the accepted cut point of 12 performed less well (sensitivity 94%, specificity 23%, +LR=1.22 -LR+0.26). CONCLUSIONS The AUSDRISK tool has the potential to be used as a screening tool for pre-diabetes/diabetes in GP practices. A cut point of ≥17 would potentially identify 75% of all people at risk and three in 10 sent for further testing would be positive for prediabetes or diabetes. Implications for public health: Routine case-finding in high-risk patients will enable GPs to intervene early and prevent further public health burden from the sequelae of diabetes.
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Affiliation(s)
- Kerry Fleming
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Endocrinology and Diabetes Service and Diabetes Alliance, Hunter New England Health Local Health District (HNELHD), New south Wales.,Hunter Medical Research Institute, Newcastle, New South Wales
| | - Natasha Weaver
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Newcastle, New South Wales
| | - Roseanne Peel
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Newcastle, New South Wales
| | - Alexis Hure
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Newcastle, New South Wales
| | - Mark McEvoy
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,La Trobe Rural Health School, College of Science, Health and Engineering, Victoria
| | - Elizabeth Holliday
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Newcastle, New South Wales
| | - Martha Parsons
- Endocrinology and Diabetes Service and Diabetes Alliance, Hunter New England Health Local Health District (HNELHD), New south Wales
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Endocrinology and Diabetes Service and Diabetes Alliance, Hunter New England Health Local Health District (HNELHD), New south Wales.,Division Of Medicine, HNELHD, New South Wales
| | - Judy Luu
- Endocrinology and Diabetes Service and Diabetes Alliance, Hunter New England Health Local Health District (HNELHD), New south Wales.,Division Of Medicine, HNELHD, New South Wales
| | - John Wiggers
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,HNELHD, New South Wales
| | - Chris Rissel
- The University of Sydney, Camperdown, New south Wales
| | - Priyanga Ranasinghe
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Ranil Jayawardena
- Department of Pharmacology, Faculty of Medicine, University of Colombo, Sri Lanka.,Department of Physiology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Samir Samman
- School of Life and Environmental Sciences, University of Sydney, New South Wales
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, Newcastle, New South Wales.,Division Of Medicine, HNELHD, New South Wales
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30
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Sutherland R, Campbell E, McLaughlin M, Nathan N, Wolfenden L, Lubans DR, Morgan PJ, Gillham K, Oldmeadow C, Searles A, Reeves P, Williams M, Evans N, Bailey A, Boyer J, Lecathelinais C, Davies L, McKenzie T, Robertson K, Wiggers J. Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 24-month implementation and cost outcomes from a cluster randomised controlled trial. Int J Behav Nutr Phys Act 2021; 18:137. [PMID: 34688281 PMCID: PMC8542325 DOI: 10.1186/s12966-021-01206-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background Physical Activity 4 Everyone (PA4E1) is an evidence-based program effective at increasing adolescent physical activity (PA) and improving weight status. This study aimed to determine a) the effectiveness of an adapted implementation intervention to scale-up PA4E1 at 24-month follow-up, b) fidelity and reach, and c) the cost and cost-effectiveness of the implementation support intervention. Methods A cluster randomised controlled trial using a type III hybrid implementation-effectiveness design in 49 lower socio-economic secondary schools, randomised to a program (n = 24) or control group (n = 25). An adapted implementation intervention consisting of seven strategies was developed to support schools to implement PA4E1 over 24-months. The primary outcome was the proportion of schools implementing at least four of the 7 PA practices, assessed via computer assisted telephone interviews (CATI) with Head Physical Education Teachers. Secondary outcomes included the mean number of PA practices implemented, fidelity and reach, cost and cost-effectiveness. Logistic regression models assessed program effects. Results At baseline, no schools implemented four of the 7 PA practices. At 24-months, significantly more schools in the program group (16/23, 69.6%) implemented at least four of the 7 PA practices than the control group (0/25, 0%) (p < 0.001). At 24-months, program schools were implementing an average of 3.6 more practices than control schools (4.1 (1.7) vs. 0.5 (0.8), respectively) (P < 0.001). Fidelity and reach of the implementation intervention were high (> 75%). The total cost of the program was $415,112 AUD (2018) ($17,296 per school; $117.30 per student). Conclusions The adapted implementation intervention provides policy makers and researchers with an effective and potentially cost-effective model for scaling-up the delivery of PA4E1 in secondary schools. Further assessment of sustainability is warranted. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-021-01206-8.
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Matthew McLaughlin
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia. .,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - David R Lubans
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Philip J Morgan
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Karen Gillham
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Chris Oldmeadow
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Penny Reeves
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Mandy Williams
- South Western Sydney Local Health District, Locked Mail Bag, 7279, BC1871, Liverpool, NSW, Australia
| | - Nicole Evans
- Central Coast Local Health District, 4-6 Watt Street, Gosford, NSW, 2250, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, P.O. Box 126, Port Macquarie, NSW, Australia
| | - James Boyer
- New South Wales Department of Education, School Sports Unit, Level 3, 1 Oxford Street, Darlinghurst, NSW, 2010, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Lynda Davies
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tom McKenzie
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Katie Robertson
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - John Wiggers
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.,Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
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31
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Kingsland M, Hollis J, Farragher E, Wolfenden L, Campbell K, Pennell C, Reeves P, Tully B, Daly J, Attia J, Oldmeadow C, Hunter M, Murray H, Paolucci F, Foureur M, Rissel C, Gillham K, Wiggers J. An implementation intervention to increase the routine provision of antenatal care addressing gestational weight gain: study protocol for a stepped-wedge cluster trial. Implement Sci Commun 2021; 2:118. [PMID: 34666840 PMCID: PMC8525056 DOI: 10.1186/s43058-021-00220-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background Weight gain during pregnancy that is outside of recommended levels is associated with a range of adverse outcomes for the mother and child, including gestational diabetes, pre-eclampsia, preterm birth, and obesity. Internationally, 60–80% of pregnant women report gaining weight outside of recommended levels. While guideline recommendations and RCT evidence support the provision of antenatal care that supports healthy gestational weight gain, less than 10% of health professionals routinely weigh pregnant women; discuss weight gain, diet, and physical activity; and provide a referral for additional support. This study aims to determine the effectiveness of an implementation intervention in increasing the provision of recommended gestational weight gain care by maternity services. Methods A stepped-wedge controlled trial, with a staggered implementation intervention, will be conducted across maternity services in three health sectors in New South Wales, Australia. The implementation intervention will consist of evidence-based, locally-tailored strategies including guidelines and procedures, reminders and prompts, leadership support, champions, training, and monitoring and feedback. Primary outcome measures will be the proportion of women who report receiving (i) assessment of gestational weight gain; (ii) advice on gestational weight gain, dietary intake, and physical activity; and (iii) offer of referral to a telephone coaching service or local dietetics service. Measurement of outcomes will occur via telephone interviews with a random sample of women who attend antenatal appointments each week. Economic analyses will be undertaken to assess the cost, cost-consequence, cost-effectiveness, and budget impact of the implementation intervention. Receipt of all care elements, acceptance of referral, weight gain during pregnancy, diet quality, and physical activity will be measured as secondary outcomes. Process measures including acceptability, adoption, fidelity, and reach will be reported. Discussion This will be the first controlled trial to evaluate the effectiveness of a implementation intervention in improving antenatal care that addresses gestational weight gain. The findings will inform decision-making by maternity services and policy agencies and, if the intervention is demonstrated to be effective, could be applied at scale to benefit the health of women and children across Australia and internationally. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12621000054819. Registered on 22 January 2021
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Affiliation(s)
- Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia. .,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia. .,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia. .,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Jenna Hollis
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Eva Farragher
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Victoria, Australia
| | - Craig Pennell
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Penny Reeves
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Justine Daly
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - John Attia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Mandy Hunter
- Nursing and Midwifery Services, Hunter New England Local Health District, New Lambton Heights, New South Wales, Australia
| | - Henry Murray
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Department of Maternal Fetal Medicine, Maternity and Gynaecology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Francesco Paolucci
- Faculty of Business and Law, The University of Newcastle, Newcastle, New South Wales, Australia.,The School of Economics and Management, University of Bologna, Bologna, Italy
| | - Maralyn Foureur
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Newcastle, New South Wales, Australia.,Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Hunter New England Health Nursing and Midwifery Research Centre, Newcastle, New South Wales, Australia
| | - Chris Rissel
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, New South Wales, Australia.,Flinders University, Darwin, Northern Territory, Australia.,Early Prevention of Obesity in Childhood Centre for Research Excellence, Sydney, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia.,School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.,Priority Research Centre in Health Behaviour, The University of Newcastle, Callaghan, New South Wales, Australia
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32
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Delaney T, Mclaughlin M, Hall A, Yoong SL, Brown A, O’Brien K, Dray J, Barnes C, Hollis J, Wyse R, Wiggers J, Sutherland R, Wolfenden L. Associations between Digital Health Intervention Engagement and Dietary Intake: A Systematic Review. Nutrients 2021; 13:nu13093281. [PMID: 34579158 PMCID: PMC8470016 DOI: 10.3390/nu13093281] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/09/2021] [Accepted: 09/15/2021] [Indexed: 11/23/2022] Open
Abstract
There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake; however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.
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Affiliation(s)
- Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +612-49246-499
| | - Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
- Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, VIC 3122, Australia
| | - Alison Brown
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Kate O’Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Julia Dray
- School of Psychology, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Jenna Hollis
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia; (M.M.); (A.H.); (S.L.Y.); (A.B.); (K.O.); (J.D.); (C.B.); (J.H.); (R.W.); (J.W.); (R.S.); (L.W.)
- Hunter New England Population Health, Wallsend, NSW 2287, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- Priority Research Centre for Heath Behavior, University of Newcastle, Callaghan, NSW 2308, Australia
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33
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Wyse R, Delaney T, Stacey F, Zoetemeyer R, Lecathelinais C, Lamont H, Ball K, Campbell K, Rissel C, Attia J, Wiggers J, Yoong SL, Oldmeadow C, Sutherland R, Nathan N, Reilly K, Wolfenden L. Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students' Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e26054. [PMID: 34491207 PMCID: PMC8456336 DOI: 10.2196/26054] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/16/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. Objective This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. Methods The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. Results From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. Conclusions Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-030538
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Affiliation(s)
- Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Rachel Zoetemeyer
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | | | - Hannah Lamont
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Karen Campbell
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
| | - Chris Rissel
- School of Public Health, University of Sydney, Sydney, Australia
| | - John Attia
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | | | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia
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Yoong SL, Hall A, Leonard A, McCrabb S, Wiggers J, Tursan d'Espaignet E, Stockings E, Gouda H, Fayokun R, Commar A, Prasad VM, Paul C, Oldmeadow C, Chai LK, Thompson B, Wolfenden L. Prevalence of electronic nicotine delivery systems and electronic non-nicotine delivery systems in children and adolescents: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e661-e673. [PMID: 34274048 PMCID: PMC8390387 DOI: 10.1016/s2468-2667(21)00106-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/26/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND There are concerns that the use of electronic nicotine delivery systems (ENDS) and electronic non-nicotine delivery systems (ENNDS) in children and adolescents could potentially be harmful to health. Understanding the extent of use of these devices is crucial to informing public health policy. We aimed to synthesise the prevalence of ENDS or ENNDS use in children and adolescents younger than 20 years. METHODS In this systematic review and meta-analysis, we undertook an electronic search in five databases (MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, and Wiley Cochrane Library) from Jan 1, 2016, to Aug 31, 2020, and a grey literature search. Included studies reported on the prevalence of ENDS or ENNDS use in nationally representative samples in populations younger than 20 years and collected data between the years 2016 and 2020. Studies were excluded if they were done in those aged 20 years or older, used data from specialist panels that did not apply appropriate weighting, or did not use methods that ensured recruitment of a nationally representative sample. We included the most recent data for each country. We combined multiple national estimates for a country if they were done in the same year. We undertook risk of bias assessment for all surveys included in the review using the Joanna Briggs Institute Critical Appraisal Checklist (by two reviewers in the author list). A random effects meta-analysis was used to pool overall prevalence estimates for ever, current, occasional, and daily use. This study was prospectively registered with PROSPERO, CRD42020199485. FINDINGS The most recent prevalence data from 26 national surveys representing 69 countries and territories, with a median sample size of 3925 (IQR 1=2266, IQR 3=10 593) children and adolescents was included. In children and adolescents aged between 8 years and younger than 20 years, the pooled prevalence for ever (defined as any lifetime use) ENDS or ENNDS use was 17·2% (95% CI 15-20, I2=99·9%), whereas for current use (defined as use in past 30 days) the pooled prevalence estimate was 7·8% (6-9, I2=99·8%). The pooled estimate for occasional use was 0·8% (0·5-1·2, I2=99·4%) for daily use and 7·5% (6·1-9·1, I2=99·4%) for occasional use. Prevalence of ENDS or ENNDS use was highest in high-income geographical regions. In terms of study quality, all surveys scored had a low risk of bias for the sampling frame used, due to the nationally representative nature of the studies. The most poorly conducted methodological feature of the included studies was subjects and setting described in detail. Few surveys reported on the use of flavours or types of ENDS or ENNDS. INTERPRETATION There is significant variability in the prevalence of ENDS and ENNDS use in children and adolescents globally by country income status. These findings are possibly due to differences in regulatory context, market availability, and differences in surveillance systems. FUNDING World Health Organization and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Sze Lin Yoong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
| | - Alecia Leonard
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
| | - Edouard Tursan d'Espaignet
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia; School of Rural Medicine, University of New England, Armidale, NSW, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia
| | - Hebe Gouda
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Ranti Fayokun
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Alison Commar
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Vinayak M Prasad
- Department of Health Promotion, No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | | | - Li Kheng Chai
- Health and Wellbeing Queensland, Queensland Government, Milton, QLD, Australia; Centre for Children's Health Research, Institute of Health and Biomedical Innovation Exercise and Nutrition, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Bruce Thompson
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia
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Gibson L, Clinton-McHarg T, Wilczynska M, Latter J, Bartlem K, Henderson C, Wiggers J, Wilson A, Searles A, Bowman J. Preventive care practices to address health behaviours among people living with mental health conditions: A survey of Community Managed Organisations. Prev Med Rep 2021; 23:101495. [PMID: 34336560 PMCID: PMC8313583 DOI: 10.1016/j.pmedr.2021.101495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/26/2022] Open
Abstract
People living with mental health conditions have a reduced life expectancy of approximately 10 years compared to the general population, largely due to physical chronic diseases and higher rates of tobacco smoking, poor nutrition, harmful alcohol consumption, physical inactivity and poor sleep behaviours. Community managed organisations (CMOs) may play a valuable role in providing preventive care to people with mental health conditions (consumers) to address these health behaviours. This paper reports the findings of a cross-sectional survey undertaken between November 2018 and February 2019 with leaders of CMOs (n = 76) that support people with mental health conditions in the state of New South Wales, Australia to: 1) measure the provision of preventive care (screening, support, and connections to specialist services) for five health behaviours; 2) identify the presence of key organisational features (e.g., data collection, staff training); and 3) explore if these organisational features were associated with the provision of preventive care. Preventive care provision to a majority of consumers (50% or more) was least frequently reported for tobacco smoking and most frequently reported for physical activity. Staff training and guidelines regarding the provision of preventive care were associated with the provision of such care. The results demonstrate that CMOs are already engaged in providing preventive care to some extent, with certain behaviours and preventive care elements addressed more frequently than others. Further research with additional CMO stakeholders, including staff and consumers, is needed to gain a deeper understanding of factors that may underlie CMOs capacity to routinely provide preventive care.
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Affiliation(s)
- Lauren Gibson
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Tara Clinton-McHarg
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Magdalena Wilczynska
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Joanna Latter
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
| | - Kate Bartlem
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | | | - John Wiggers
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Andrew Wilson
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Australia
| | - Andrew Searles
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jenny Bowman
- School of Psychological Sciences, College of Engineering, Science & Environment, University of Newcastle, Callaghan, NSW, Australia
- The Australian Prevention Partnership Centre (TAPPC), Sax Institute, Ultimo, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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36
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Mclaughlin M, Duff J, McKenzie T, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Evaluating Digital Program Support for the Physical Activity 4 Everyone (PA4E1) School Program: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e26690. [PMID: 34309565 PMCID: PMC8367175 DOI: 10.2196/26690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 05/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Effectively scaled-up physical activity interventions are urgently needed to address the high prevalence of physical inactivity. To facilitate scale-up of an efficacious school-based physical activity program (Physical Activity 4 Everyone [PA4E1]), provision of implementation support to physical education (PE) teachers was adapted from face-to-face and paper-based delivery modes to partial delivery via a website. A lack of engagement (usage and subjective experience) with digital delivery modes, including websites, may in part explain the typical reduction in effectiveness of scaled-up interventions that use digital delivery modes. A process evaluation focused on the PA4E1 website was undertaken. OBJECTIVE The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school champions (PE teachers leading the program within their schools) and PE teachers using quantitative methods; (2) examine the usage, subjective experience, and usability of the PA4E1 program website from the perspective of in-school champions using mixed methods. METHODS The first objective used website usage data collected across all users (n=273) throughout the 9 school terms of the PA4E1 implementation support. The 4 usage measures were sessions, page views, average session duration, and downloads. Descriptive statistics were calculated and explored across the duration of the 26-month program. The second objective used mixed methods, triangulating data from the first objective with data from a think-aloud survey and usability test completed by in-school champions (n=13) at 12 months. Qualitative data were analyzed thematically alongside descriptive statistics from the quantitative data in a triangulation matrix, generating cross-cutting themes using the "following a thread" approach. RESULTS For the first objective, in-school champions averaged 48.0 sessions per user, PE teachers 5.8 sessions. PE teacher sessions were of longer duration (10.5 vs 7.6 minutes) and included more page views (5.4 vs 3.4). The results from the mixed methods analysis for the second objective found 9 themes and 2 meta-themes. The first meta-theme indicated that the website was an acceptable and appropriate delivery mode, and usability of the website was high. The second meta-theme found that the website content was acceptable and appropriate, and identified specific suggestions for improvement. CONCLUSIONS Digital health interventions targeting physical activity often experience issues of lack of user engagement. By contrast, the findings from both the quantitative and mixed methods analyses indicate high usage and overall acceptability and appropriateness of the PA4E1 website to school teachers. The findings support the value of the website within a multidelivery mode implementation intervention to support schools to implement physical activity promoting practices. The analysis identified suggested intervention refinements, which may be adopted for future iterations and further scale-up of the PA4E1 program. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12617000681358; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Jed Duff
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, Australia
| | - Tom McKenzie
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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37
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Sutherland R, Brown A, Nathan N, Yoong S, Janssen L, Chooi A, Hudson N, Wiggers J, Kerr N, Evans N, Gillham K, Oldmeadow C, Searles A, Reeves P, Davies M, Reilly K, Cohen B, Wolfenden L. A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness-Implementation Hybrid Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e25256. [PMID: 34185013 PMCID: PMC8277365 DOI: 10.2196/25256] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/20/2020] [Accepted: 01/20/2021] [Indexed: 12/31/2022] Open
Abstract
Background There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. Conclusions The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Trial Registration Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID) RR2-10.1186/s12889-019-7725-x
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Affiliation(s)
- Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Alison Brown
- Hunter New England Population Health, Wallsend, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Serene Yoong
- Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia.,Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Lisa Janssen
- Hunter New England Population Health, Wallsend, Australia
| | - Amelia Chooi
- Hunter New England Population Health, Wallsend, Australia
| | - Nayerra Hudson
- Hunter New England Population Health, Wallsend, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Nicola Kerr
- Mid North Coast Local Health District, Port Macquarie, Australia
| | - Nicole Evans
- Central Coast Local Health District, Gosford, Australia
| | - Karen Gillham
- Hunter New England Population Health, Wallsend, Australia
| | | | - Andrew Searles
- Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Penny Reeves
- Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Marc Davies
- New South Wales Ministry of Health, Liverpool, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | | | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia
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Atorkey P, Paul C, Wiggers J, Bonevski B, Nolan E, Oldmeadow C, Mitchell A, Byrnes E, Tzelepis F. Clustering of multiple health-risk factors among vocational education students: a latent class analysis. Transl Behav Med 2021; 11:1931-1940. [PMID: 34155507 DOI: 10.1093/tbm/ibab068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Physical and mental health risks often commence during young adulthood. Vocational education institutions are an ideal setting for understanding how health-risks cluster together in students to develop holistic multiple health-risk interventions. This is the first study to examine clustering of tobacco smoking, fruit intake, vegetable intake, alcohol consumption, physical inactivity, overweight/obesity, depression, and anxiety in vocational education students and the socio-demographic characteristics associated with cluster membership. A cross-sectional survey with vocational education students (n = 1134, mean age = 24.3 years) in New South Wales, Australia. Latent class analysis identified clusters and latent class regression examined characteristics associated with clusters. Four clusters were identified. All clusters had moderate inadequate fruit intake and moderate overweight/obesity. Cluster 1 (13% of sample) had "high anxiety, high inadequate vegetable intake, low tobacco, and low alcohol use." Cluster 2 (16% of sample) had "high tobacco smoking, high alcohol use, high anxiety, high depression, and high inadequate vegetable intake." Cluster 3 (52% of sample) had "high risky alcohol use, high inadequate vegetable intake, low depression, low anxiety, low tobacco smoking, and low physical inactivity." Cluster 4 (19% of sample) was a "lower risk cluster with high inadequate vegetable intake." Compared to cluster 4, 16-25-year-olds and those experiencing financial stress were more likely to belong to clusters 1, 2, and 3. Interventions for vocational education students should address fruit and vegetable intake and overweight/obesity and recognize that tobacco use and risky alcohol use sometimes occurs in the context of mental health issues.
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Affiliation(s)
- Prince Atorkey
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Christine Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Erin Nolan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Local Health District, New South Wales, Australia.,Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia.,Priority Research Centre for Health Behaviour, College of Health, Medicine and Wellbeing, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
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39
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Tsang TW, Kingsland M, Doherty E, Anderson AE, Tully B, Crooks K, Symonds I, Tremain D, Dunlop AJ, Wiggers J, Elliott EJ. Predictors of alcohol use during pregnancy in Australian women. Drug Alcohol Rev 2021; 41:171-181. [PMID: 34062031 DOI: 10.1111/dar.13330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This paper aimed to document alcohol use during pregnancy and determine predictors of ongoing use, including knowledge and agreement with national alcohol guideline recommendations. METHODS Pregnant women (n = 1179) attending public antenatal services in a Local Health District in NSW, Australia, were surveyed about their alcohol use before pregnancy and after pregnancy recognition, and awareness of, and agreement with, national alcohol guidelines and health-related statements. Respondent characteristics, drinking behaviour and predictors of ongoing drinking during pregnancy were assessed. RESULTS Most women consumed alcohol before pregnancy (79.3%) but the majority (82.0%) stopped following pregnancy recognition. Half the ongoing drinkers only drank on special occasions. Most (63.6%) women were aware of the national guidelines: 78.1% knew the recommendation that consuming no alcohol in pregnancy is safest, 4.6% thought some alcohol was safe and 17.3% were unsure. Predictors [OR (95%CI)] of ongoing drinking were older age [1.11 (1.07, 1.15)]; medium [2.42 (1.46, 4.00)] or high-risk drinking pre-pregnancy [3.93 (2.35, 6.56)]; and agreement that: avoiding alcohol in pregnancy is safest [0.05 (0.006, 0.47)]; avoiding alcohol is important for baby's health [0.14 (0.06, 0.31)] and pregnancy is a good time to change alcohol use for mother's health [0.29 (0.13, 0.63)]. DISCUSSION AND CONCLUSIONS Results emphasise the importance of asking about special occasion drinking, the link between pre-pregnancy drinking and ongoing drinking during pregnancy, and the need to understand why women disagree with the national guideline. To ensure guidelines have their intended benefit, interventions to promote behaviour change relating to alcohol consumption during pregnancy are warranted.
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Affiliation(s)
- Tracey W Tsang
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.,Sydney Children's Hospital Network, Kids Research, Sydney, Australia
| | - Melanie Kingsland
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Emma Doherty
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Amy E Anderson
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Belinda Tully
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Kristy Crooks
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Ian Symonds
- Adelaide Medical School, The University of Adelaide, Adelaide, Australia
| | - Danika Tremain
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia.,Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia
| | - John Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Elizabeth J Elliott
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney Children's Hospital Westmead Clinical School, Sydney, Australia.,Sydney Children's Hospital Network, Kids Research, Sydney, Australia
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40
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Nathan N, Hall A, McCarthy N, Sutherland R, Wiggers J, Bauman AE, Rissel C, Naylor PJ, Cradock A, Lane C, Hope K, Elton B, Shoesmith A, Oldmeadow C, Reeves P, Gillham K, Duggan B, Boyer J, Lecathelinais C, Wolfenden L. Multi-strategy intervention increases school implementation and maintenance of a mandatory physical activity policy: outcomes of a cluster randomised controlled trial. Br J Sports Med 2021; 56:385-393. [PMID: 34039583 PMCID: PMC8938653 DOI: 10.1136/bjsports-2020-103764] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 02/06/2023]
Abstract
Objectives To assess if a multi-strategy intervention effectively increased weekly minutes of structured physical activity (PA) implemented by classroom teachers at 12 months and 18 months. Methods A cluster randomised controlled trial with 61 primary schools in New South Wales Australia. The 12-month multi-strategy intervention included; centralised technical assistance, ongoing consultation, principal’s mandated change, identifying and preparing school champions, development of implementation plans, educational outreach visits and provision of educational materials. Control schools received usual support (guidelines for policy development via education department website and telephone support). Weekly minutes of structured PA implemented by classroom teachers (primary outcome) was measured via teacher completion of a daily log-book at baseline (October–December 2017), 12-month (October–December 2018) and 18-month (April–June 2019). Data were analysed using linear mixed effects regression models. Results Overall, 400 class teachers at baseline, 403 at 12 months follow-up and 391 at 18 months follow-up provided valid primary outcome data. From baseline to 12-month follow-up, teachers at intervention schools recorded a greater increase in weekly minutes of PA implemented than teachers assigned to the control schools by approximately 44.2 min (95% CI 32.8 to 55.7; p<0.001) which remained at 18 months, however, the effect size was smaller at 27.1 min (95% CI 15.5 to 38.6; p≤0.001). Conclusion A multi-strategy intervention increased mandatory PA policy implementation. Some, but not all of this improvement was maintained after implementation support concluded. Further research should assess the impact of scale-up strategies on the sustainability of PA policy implementation over longer time periods. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12617001265369).
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Affiliation(s)
- Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia .,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Nicole McCarthy
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - John Wiggers
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Adrian E Bauman
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- Centre for Health Advancement, NSW Health, North Sydney, New South Wales, Australia
| | - Patt-Jean Naylor
- School of Exercise Science, Physical and Heal, University of Victoria, Victoria, British Columbia, Canada
| | - Angie Cradock
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Cassandra Lane
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Kirsty Hope
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia
| | - Benjamin Elton
- Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | | | - Penny Reeves
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia
| | - Bernadette Duggan
- Catholic Schools Office Diocese of Maitland-Newcastle, Newcastle, New South Wales, Australia
| | - James Boyer
- School Sport Unit, NSW Department of Education, Turrella, New South Wales, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Population Health, Hunter New England Health, Wallsend, New South Wales, Australia.,Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia
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41
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Hall A, O'Brien K, McCrabb S, Kypri K, Brown S, Wilczynska M, Wiggers J, Wyse R, Dalton C, Wolfenden L. Learnings from efforts to synthesise evidence on the COVID-19 incubation period. Public Health 2021; 198:e12-e13. [PMID: 34130808 PMCID: PMC8112467 DOI: 10.1016/j.puhe.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Affiliation(s)
- A Hall
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia.
| | - K O'Brien
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
| | - S McCrabb
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
| | - K Kypri
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW Australia
| | - S Brown
- Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; School of Psychology, The University of Newcastle, Newcastle, NSW Australia
| | - M Wilczynska
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia
| | - J Wiggers
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
| | - R Wyse
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
| | - C Dalton
- Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
| | - L Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Hunter New England Population Health, Hunter New England Area Health Service, Newcastle, Australia
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42
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Byaruhanga J, Paul CL, Wiggers J, Byrnes E, Mitchell A, Lecathelinais C, Bowman J, Campbell E, Gillham K, Tzelepis F. The short-term effectiveness of real-time video counselling on smoking cessation among residents in rural and remote areas: An interim analysis of a randomised trial. J Subst Abuse Treat 2021; 131:108448. [PMID: 34098302 DOI: 10.1016/j.jsat.2021.108448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Real-time video counselling for smoking cessation uses readily accessible software (e.g. Skype). This study aimed to assess the short-term effectiveness of real-time video counselling compared to telephone counselling or written materials (minimal intervention control) on smoking cessation and quit attempts among rural and remote residents. METHODS An interim analysis of a three-arm, parallel group randomised trial with participants (n = 655) randomly allocated to; 1) real-time video counselling; 2) telephone counselling; or 3) written materials only (minimal intervention control). Participants were daily tobacco users aged 18 years or older residing in rural or remote areas of New South Wales, Australia. Video and telephone counselling conditions offered up to six counselling sessions while those in the minimal intervention control condition were mailed written materials. The study measured seven-day point prevalence abstinence, prolonged abstinence and quit attempts at 4-months post-baseline. RESULTS Video counselling participants were significantly more likely than the minimal intervention control group to achieve 7-day point prevalence abstinence at 4-months (18.9% vs 8.9%, OR = 2.39 (1.34-4.26), p = 0.003), but the video (18.9%) and telephone (12.7%) counselling conditions did not differ significantly for 7-day point prevalence abstinence. The video counselling and minimal intervention control groups or video counselling and telephone counselling groups did not differ significantly for three-month prolonged abstinence or quit attempts. CONCLUSION Given video counselling may increase cessation rates at 4 months post-baseline, quitlines and other smoking cessation services may consider integrating video counselling into their routine practices as a further mode of cessation care delivery. TRIAL REGISTRATION www.anzctr.org.au ACTRN12617000514303.
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Affiliation(s)
- Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia.
| | - Christine L Paul
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Christophe Lecathelinais
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Jennifer Bowman
- Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia; School of Psychology, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, New South Wales 2308, Australia; Hunter New England Population Health, Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, New South Wales 2287, Australia; Hunter Medical Research Institute, Locked bag 1000, New Lambton Heights, New South Wales 2305, Australia
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43
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Bartlem K, Gibson L, Fehily C, Lodge S, Wiggers J, Bowman J. Multiple health behaviours and interest in change among people with a mental health condition: A brief report. Prev Med Rep 2021; 22:101383. [PMID: 33996395 PMCID: PMC8102994 DOI: 10.1016/j.pmedr.2021.101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/22/2021] [Accepted: 04/10/2021] [Indexed: 11/23/2022] Open
Abstract
78% engaged in multiple risk behaviours. 68% interested in improving multiple behaviours. Multiple behaviours need addressing for this population. Multi-behavioural interventions should be considered.
People with a mental illness experience a disproportionate burden of chronic disease morbidity and mortality; contributed to by a higher prevalence of health risk behaviours that increase the risk of chronic disease development. Amongst this population there is little understanding of multiple risk behaviour co-occurrence and client interest in improving multiple such risks. A cross-sectional survey was undertaken with a random selection of 557 clients of 12 community mental health services in Australia. Participants reported their engagement in health risk behaviours (tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption, and inadequate physical activity), and those deemed ‘at risk’ reported whether they were seriously considering improving their risk behaviours. Almost all participants engaged in at least one risk behaviour (96.1%), with 78.4% of participants engaging in two or more risk behaviours. Of those with two risks, the most frequently paired behaviours were inadequate fruit and vegetable consumption and inadequate physical activity (39.7%); of those with three risks the most common combination was inadequate fruit and vegetable consumption, tobacco smoking and harmful alcohol consumption (42.5%). Of those at risk for all behaviours, 68.4% were interested in improving multiple behaviours, and 14% were interested in improving all; with these participants being most frequently interested in changing smoking, nutrition, and physical activity (19.3%), followed by all risk behaviours (14.0%). The findings strengthen the evidence that people with a mental illness are interested in improving their health risk behaviours and indicate a need to address the multiple health risks in this population group.
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Affiliation(s)
- Kate Bartlem
- School of Psychology, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia
| | - Lauren Gibson
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Caitlin Fehily
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Simone Lodge
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- Hunter New England Population Health, Wallsend, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Jenny Bowman
- School of Psychology, University of Newcastle, Callaghan, Australia
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44
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Mclaughlin M, Delaney T, Hall A, Byaruhanga J, Mackie P, Grady A, Reilly K, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Correction: Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e29094. [PMID: 33780346 PMCID: PMC8088875 DOI: 10.2196/29094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/23180.].
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia.,Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter New England Population Health, Wallsend, Australia.,Hunter Medical Research Institute, New Lambton Heights, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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45
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Metse AP, Fehily C, Clinton-McHarg T, Wynne O, Lawn S, Wiggers J, Bowman JA. Self-reported suboptimal sleep and receipt of sleep assessment and treatment among persons with and without a mental health condition in Australia: a cross sectional study. BMC Public Health 2021; 21:463. [PMID: 33676472 PMCID: PMC7937198 DOI: 10.1186/s12889-021-10504-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/25/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Poor sleep and poor mental health go hand in hand and, together, can have an adverse impact on physical health. Given the already disproportionate physical health inequities experienced by people with a mental health condition worldwide, the need to consider and optimise sleep has been highlighted as a means of improving both physical and mental health status. Sleep recommendations recently developed by the United States' National Sleep Foundation incorporate a range of sleep parameters and enable the identification of 'suboptimal' sleep. Among community-dwelling persons with and without a 12-month mental health condition in Australia, this study reports: [1] the prevalence of 'suboptimal' sleep and [2] rates of sleep assessment by a health care clinician/service and receipt of and desire for sleep treatment. METHODS A descriptive study (N = 1265) was undertaken using self-report data derived from a cross-sectional telephone survey of Australian adults, undertaken in 2017. RESULTS Fifteen per cent (n = 184) of participants identified as having a mental health condition in the past 12 months. Across most (7 of 8) sleep parameters, the prevalence of suboptimal sleep was higher among people with a mental health condition, compared to those without (all p < 0.05). The highest prevalence of suboptimal sleep for both groups was seen on measures of sleep duration (36-39% and 17-20% for people with and without a mental health condition, respectively). In terms of sleep assessment and treatment, people with a mental health condition were significantly more likely to: desire treatment (37% versus 16%), have been assessed (38% versus 12%) and have received treatment (30% versus 7%). CONCLUSIONS The prevalence of suboptimal sleep among persons with a mental health condition in Australia is significantly higher than those without such a condition, and rates of assessment and treatment are low for both groups, but higher for people with a mental health condition. Population health interventions, including those delivered as part of routine health care, addressing suboptimal sleep are needed.
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Affiliation(s)
- Alexandra P. Metse
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- University of the Sunshine Coast, 90 South Street, Murdoch, WA 6150 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Murdoch University, 90 Sippy Downs Drive, Sippy Downs, QLD 4556 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Tara Clinton-McHarg
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
| | - Sharon Lawn
- Flinders University, Sturt Rd, Bedford Park, SA 5042 Australia
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
- Hunter New England Population Health, Longworth Avenue, Wallsend, NSW 2287 Australia
| | - Jenny A. Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305 Australia
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46
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Wiggers J, Tindall J, Hodder RK, Gillham K, Kingsland M, Lecathelinais C. Public opinion and experiences of crime two and five years following the implementation of a targeted regulation of licensed premises in Newcastle, Australia. Drug Alcohol Rev 2021; 40:489-498. [PMID: 33215797 PMCID: PMC7984221 DOI: 10.1111/dar.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS In 2008 additional licensing restrictions were imposed on 'high-risk' licensed premises in the entertainment precinct of Newcastle (Australia) including earlier closing, a 'lock-out' and additional responsible service of alcohol restrictions. A study was conducted to assess community perceptions, experiences of crime and support for the restrictions, 2 and 5 years following implementation. DESIGN AND METHODS Telephone surveys were conducted with random samples of Newcastle community members (≥18 years) in 2010 and 2013. Change over time in perceptions and experiences of crime, and awareness and support of the conditions was analysed using logistic regression analyses for all participants, and separately for night-time visitors. RESULTS Among all participants (2010: n = 376; 2013: n = 314) the perception that alcohol misuse was a problem declined between 2010 and 2013 for all participants (90% to 85%; P = 0.02), and specifically among night-time visitors (87% to 75%; P = 0.06). Awareness of the restrictions was high among all participants and sub-groups, and remained constant over time. Support for the restrictions was also high, with drink restrictions being the most popular. More night-time visitors reported that conditions made the streets safer in 2013 (62%) than 2010 (47%; P = 0.05). Support for applying restrictions to all licensed premises in the Newcastle entertainment precinct (83%) and across New South Wales was high in 2013 (86%). DISCUSSION AND CONCLUSIONS At 2 years and 5 years following implementation of additional licensing restrictions, significant improvements in public perceptions of the occurrence of alcohol-related harm and crime were evident, as were high levels of support for the restrictions.
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Affiliation(s)
- John Wiggers
- Hunter New England Population HealthNewcastleAustralia
- School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Jenny Tindall
- Hunter New England Population HealthNewcastleAustralia
| | - Rebecca K. Hodder
- Hunter New England Population HealthNewcastleAustralia
- School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Karen Gillham
- Hunter New England Population HealthNewcastleAustralia
| | - Melanie Kingsland
- Hunter New England Population HealthNewcastleAustralia
- School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
| | - Christophe Lecathelinais
- Hunter New England Population HealthNewcastleAustralia
- School of Medicine and Public HealthThe University of NewcastleNewcastleAustralia
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47
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Mclaughlin M, Delaney T, Hall A, Byaruhanga J, Mackie P, Grady A, Reilly K, Campbell E, Sutherland R, Wiggers J, Wolfenden L. Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis. J Med Internet Res 2021; 23:e23180. [PMID: 33605897 PMCID: PMC8011420 DOI: 10.2196/23180] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The effectiveness of digital health interventions is commonly assumed to be related to the level of user engagement with the digital health intervention, including measures of both digital health intervention use and users' subjective experience. However, little is known about the relationships between the measures of digital health intervention engagement and physical activity or sedentary behavior. OBJECTIVE This study aims to describe the direction and strength of the association between engagement with digital health interventions and physical activity or sedentary behavior in adults and explore whether the direction of association of digital health intervention engagement with physical activity or sedentary behavior varies with the type of engagement with the digital health intervention (ie, subjective experience, activities completed, time, and logins). METHODS Four databases were searched from inception to December 2019. Grey literature and reference lists of key systematic reviews and journals were also searched. Studies were eligible for inclusion if they examined a quantitative association between a measure of engagement with a digital health intervention targeting physical activity and a measure of physical activity or sedentary behavior in adults (aged ≥18 years). Studies that purposely sampled or recruited individuals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the individual engaging with the digital health intervention was not the target of the physical activity intervention, the study had a non-digital health intervention component, or the digital health interventions targeted multiple health behaviors. A random effects meta-analysis and direction of association vote counting (for studies not included in meta-analysis) were used to address objective 1. Objective 2 used vote counting on the direction of the association. RESULTS Overall, 10,653 unique citations were identified and 375 full texts were reviewed. Of these, 19 studies (26 associations) were included in the review, with no studies reporting a measure of sedentary behavior. A meta-analysis of 11 studies indicated a small statistically significant positive association between digital health engagement (based on all usage measures) and physical activity (0.08, 95% CI 0.01-0.14, SD 0.11). Heterogeneity was high, with 77% of the variation in the point estimates explained by the between-study heterogeneity. Vote counting indicated that the relationship between physical activity and digital health intervention engagement was consistently positive for three measures: subjective experience measures (2 of 3 associations), activities completed (5 of 8 associations), and logins (6 of 10 associations). However, the direction of associations between physical activity and time-based measures of usage (time spent using the intervention) were mixed (2 of 5 associations supported the hypothesis, 2 were inconclusive, and 1 rejected the hypothesis). CONCLUSIONS The findings indicate a weak but consistent positive association between engagement with a physical activity digital health intervention and physical activity outcomes. No studies have targeted sedentary behavior outcomes. The findings were consistent across most constructs of engagement; however, the associations were weak.
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Affiliation(s)
- Matthew Mclaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Tessa Delaney
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Alix Hall
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Judith Byaruhanga
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Paul Mackie
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia
- Centre for Research Excellence in Stroke Recovery and Rehabilitation, Florey Institute of Neuroscience, Melbourne, Australia
| | - Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Elizabeth Campbell
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter New England Population Health, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton Heights, Australia
- Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, Australia
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Sutherland R, Ying Ooi J, Finch M, Yoong SL, Nathan N, Wrigley J, Reilly K, Janssen L, Wiggers J, Wolfenden L. A cluster randomised controlled trial of a secondary school intervention to reduce intake of sugar-sweetened beverages: Mid-intervention impact of switchURsip environmental strategies. Health Promot J Austr 2021; 33:176-186. [PMID: 33577117 DOI: 10.1002/hpja.469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 02/06/2021] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Secondary schools provide an opportune setting for interventions addressing excessive sugar-sweetened beverage (SSB) intake in adolescence. This trial aimed to assess the impact of school environmental strategies, delivered as part of a broader intervention, among Year 7-9 students' SSB consumption. METHODS Between March and July 2018, we conducted a cluster randomised controlled trial with 862 students attending six secondary schools (3 intervention and 3 control) in New South Wales. The intervention targeted SSB availability, placement, promotion and pricing, and increased availability and promotion of water. Control schools followed their usual programmes. Primary outcomes included mean daily SSB consumption (millilitres) and mean daily percentage energy from SSB (kilojoules). Sub-group analysis explored primary outcomes for gender, school year level and frequency of canteen use. RESULTS Of the 2265 eligible students, 1092 (50.2%) provided active parental consent and 940 (86.0%) participated in baseline data collection. No significant differences were observed between groups at follow-up for mean daily SSBs consumed (-10.17 mL, CI: -24.78; 45.12, P = 0.57) or mean daily percentage energy from SSBs (-0.20%, CI: -0.87; 0.47, P = .56). Significant effects were observed among girls in intervention compared to girls in control schools for mean daily SSB consumption (-52.02 mL, CI 99.8; 94.14, P = .03) and mean daily percentage of energy from SSBs (-0.90%, CI: -1.82; 0.02, P = .05). CONCLUSIONS At 3-month mid-intervention evaluation, the intervention failed to impact on mean daily consumption and mean percentage energy from SSBs, overall. However, an intervention effect was observed in girls. The limited overall effect is likely due to inadequate intervention dose related to the short duration, limiting opportunities for schools to fully implement the environmental strategies. SO WHAT?: A longer intervention duration with additional implementation support to allow adequate time to embed the strategies within the school is recommended. Implementation support strategies would ensure staff are supported throughout the process.
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Affiliation(s)
- Rachel Sutherland
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Jia Ying Ooi
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Meghan Finch
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sze Lin Yoong
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Nicole Nathan
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Jessica Wrigley
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kathryn Reilly
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Lisa Janssen
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.,School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.,Priority Research Centre for Heath Behaviour, University of Newcastle, Callaghan, NSW, Australia
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Marsden DL, Boyle K, Jordan LA, Dunne JA, Shipp J, Minett F, Styles A, Birnie J, Ormond S, Parrey K, Buzio A, Lever S, Paul M, Hill K, Pollack MRP, Wiggers J, Oldmeadow C, Cadilhac DAM, Duff J. Improving Assessment, Diagnosis, and Management of Urinary Incontinence and Lower Urinary Tract Symptoms on Acute and Rehabilitation Wards That Admit Adult Patients: Protocol for a Before-and-After Implementation Study. JMIR Res Protoc 2021; 10:e22902. [PMID: 33538703 PMCID: PMC7892286 DOI: 10.2196/22902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Urinary incontinence (UI) and lower urinary tract symptoms (LUTS) are commonly experienced by adult patients in hospitals (inpatients). Although peak bodies recommend that health services have systems for optimal UI and LUTS care, they are often not delivered. For example, results from the 2017 Australian National Stroke Audit Acute Services indicated that of the one-third of acute stroke inpatients with UI, only 18% received a management plan. In the 2018 Australian National Stroke Audit Rehabilitation Services, half of the 41% of patients with UI received a management plan. There is little reporting of effective inpatient interventions to systematically deliver optimal UI/LUTS care. Objective This study aims to determine whether our UI/LUTS practice-change package is feasible and effective for delivering optimal UI/LUTS care in an inpatient setting. The package includes our intervention that has been synthesized from the best-available evidence on UI/LUTS care and a theoretically informed implementation strategy targeting identified barriers and enablers. The package is targeted at clinicians working in the participating wards. Methods This is a pragmatic, real-world, before- and after-implementation study conducted at 12 hospitals (15 wards: 7/15, 47% metropolitan, 8/15, 53% regional) in Australia. Data will be collected at 3 time points: before implementation (T0), immediately after the 6-month implementation period (T1), and again after a 6-month maintenance period (T2). We will undertake medical record audits to determine any change in the proportion of inpatients receiving optimal UI/LUTS care, including assessment, diagnosis, and management plans. Potential economic implications (cost and consequences) for hospitals implementing our intervention will be determined. Results This study was approved by the Hunter New England Human Research Ethics Committee (HNEHREC Reference No. 18/10/17/4.02). Preimplementation data collection (T0) was completed in March 2020. As of November 2020, 87% (13/15) wards have completed implementation and are undertaking postimplementation data collection (T1). Conclusions Our practice-change package is designed to reduce the current inpatient UI/LUTS evidence-based practice gap, such as those identified through national stroke audits. This study has been designed to provide clinicians, managers, and policy makers with the evidence needed to assess the potential benefit of further wide-scale implementation of our practice-change package. International Registered Report Identifier (IRRID) DERR1-10.2196/22902
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Affiliation(s)
- Dianne Lesley Marsden
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, Australia.,Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia
| | - Kerry Boyle
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, Newcastle, Australia.,Belmont Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Louise-Anne Jordan
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia
| | - Judith Anne Dunne
- Rankin Park Centre, Hunter New England Local Health District, Newcastle, Australia
| | - Jodi Shipp
- John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - Fiona Minett
- Manning Hospital and Wingham Hospital, Hunter New England Local Health District, Taree, Australia
| | - Amanda Styles
- Armidale Hospital, Hunter New England Local Health District, Armidale, Australia.,Tamworth Hospital, Hunter New England Local Health District, Tamworth, Australia
| | - Jaclyn Birnie
- Armidale Hospital, Hunter New England Local Health District, Armidale, Australia
| | | | - Kim Parrey
- Port Macquarie Hospital, Mid North Coast Local Health District, Port Macquarie, Australia
| | - Amanda Buzio
- Coffs Harbour Hospital, Mid North Coast Local Health District, Coffs Harbour, Australia
| | - Sandra Lever
- Ryde Hospital, Northern Sydney Local Health District, Sydney, Australia.,Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, Australia
| | - Michelle Paul
- Continence Service, Hunter New England Local Health District, Newcastle, Australia
| | - Kelvin Hill
- Stroke Foundation, Melbourne, Australia.,Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Michael R P Pollack
- Hunter Stroke Service, Hunter New England Local Health District, Newcastle, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia.,John Hunter Hospital, Hunter New England Local Health District, Newcastle, Australia
| | - John Wiggers
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Health Research and Translation, Hunter New England Local Health District, Newcastle, Australia.,Public Health Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Christopher Oldmeadow
- Clinical Research Design & Statistics, Hunter Medical Research Institute, Newcastle, Australia
| | - Dominique Ann-Michele Cadilhac
- Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Newcastle and Melbourne, Australia.,Stroke Theme, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia.,Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Jed Duff
- Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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50
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Wolfenden L, Foy R, Presseau J, Grimshaw JM, Ivers NM, Powell BJ, Taljaard M, Wiggers J, Sutherland R, Nathan N, Williams CM, Kingsland M, Milat A, Hodder RK, Yoong SL. Designing and undertaking randomised implementation trials: guide for researchers. BMJ 2021; 372:m3721. [PMID: 33461967 PMCID: PMC7812444 DOI: 10.1136/bmj.m3721] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Implementation science is the study of methods to promote the systematic uptake of evidence based interventions into practice and policy to improve health. Despite the need for high quality evidence from implementation research, randomised trials of implementation strategies often have serious limitations. These limitations include high risks of bias, limited use of theory, a lack of standard terminology to describe implementation strategies, narrowly focused implementation outcomes, and poor reporting. This paper aims to improve the evidence base in implementation science by providing guidance on the development, conduct, and reporting of randomised trials of implementation strategies. Established randomised trial methods from seminal texts and recent developments in implementation science were consolidated by an international group of researchers, health policy makers, and practitioners. This article provides guidance on the key components of randomised trials of implementation strategies, including articulation of trial aims, trial recruitment and retention strategies, randomised design selection, use of implementation science theory and frameworks, measures, sample size calculations, ethical review, and trial reporting. It also focuses on topics requiring special consideration or adaptation for implementation trials. We propose this guide as a resource for researchers, healthcare and public health policy makers or practitioners, research funders, and journal editors with the goal of advancing rigorous conduct and reporting of randomised trials of implementation strategies.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family Medicine and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St Louis, St Louis, MI, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Christopher M Williams
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Andrew Milat
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Rebecca K Hodder
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Sze Lin Yoong
- Swinburne University of Technology, School of Health Sciences, Faculty Health, Arts and Design, Hawthorn, VIC, Australia
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