ORCID Profile
0000-0002-6178-3868
Current Organisation
The University of Newcastle
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Publisher: The Sax Institute
Date: 10-2019
DOI: 10.57022/LOWM3578
Abstract: This Evidence Check was used to inform the program review and refresh of the ‘Live Life Well @ School’ program as part of the NSW Healthy Children Initiative. It aimed to discover the effectiveness of obesity prevention programs for children delivered in primary school settings. It also examined how best to implement them, to maximise the number of children participating and the overall impact of the programs. Eighteen studies were found to address the question of effectiveness, finding evidence for programs focused on nutrition, physical activity or a combination of them (sometimes with additional components) school food service and environments and active travel strategies. The studies addressing this question were judged to be of moderate to critically low quality. Thirty-two studies were found to address the question of implementation, finding evidence for strategies involving audit and feedback continuous quality improvement external funding education materials education meetings or outreach visits local consensus processes local opinion leaders and tailored interventions to improve implementation of healthy canteen policies.
Publisher: Wiley
Date: 04-03-2015
DOI: 10.1111/DAR.12252
Abstract: Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs. A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation. Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2) P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient. The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices.
Publisher: JMIR Publications Inc.
Date: 31-07-2020
DOI: 10.2196/17274
Abstract: Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in in idual or population health outcomes. A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on in idual or population-level health outcomes. This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.
Publisher: BMJ
Date: 03-2016
Publisher: BMJ
Date: 07-2015
Publisher: No publisher found
Date: 2012
DOI: 10.1111/J.1440-1754.2010.01776.X
Abstract: Helping parents engage in practices that are likely to prevent childhood obesity is a considerable challenge for health professionals, policy makers and researchers. The aim of the study was to determine who is likely to use services designed to help parents prevent overweight and obesity and what types of services they prefer. Two hundred and forty randomly selected parents of children 4-15 years from the Hunter New England region of New South Wales completed a 15 min telephone survey. Most parents would use a service to help them prevent obesity in their children but particularly parents of households from higher socioeconomic areas, female parents, parents of younger children and parents of children who are not consuming sufficient serves of fruits and vegetables, or are less active. Parents preferred personalised mailed print materials (85%), specialist appointments (61%) and emailed information (58%). Parents are interested in using a range of services to support them to encourage their children to eat healthily and be active. Researchers should test the efficacy of promising services.
Publisher: Springer Science and Business Media LLC
Date: 10-03-2015
Publisher: Springer Science and Business Media LLC
Date: 08-11-2016
Publisher: Wiley
Date: 03-2011
DOI: 10.1111/J.1440-1754.2010.01738.X
Abstract: The aim of this study was to describe the physical activity-related policies and practices of childcare services and to determine if service size, socioeconomic or remoteness characteristics predict such policies and practices. Authorized supervisors of 216 licensed pre-schools and long day care centres participated in a brief telephone survey. Few services had a written physical activity policy, programmed time each day for fundamental movement skill development, or had staff trained in physical activity. Twenty-eight percent of pre-schools and 30% of long day care centres provided daily opportunities for children 3-5 years to participate in sedentary screen activities. Rural pre-schools and long day care centres were more likely to program time for fundamental movement skills development, as were pre-schools from higher socioeconomic areas. There is substantial scope for childcare services to modify their policies and practices to be more supportive of child physical activity.
Publisher: BMJ
Date: 2012
Publisher: Springer Science and Business Media LLC
Date: 12-2011
Publisher: Elsevier BV
Date: 02-2016
Publisher: Elsevier BV
Date: 04-2008
DOI: 10.1016/J.YPMED.2007.12.003
Abstract: The study aimed to critically appraise the extent and strength of systematic review evidence for, and guideline recommendations regarding hospital smoking cessation interventions. Systematic reviews of smoking cessation interventions were identified via an electronic search of the Cochrane Library. Meta-analyses from Cochrane reviews were categorised as those that incorporated only studies of hospital based interventions, and those which incorporated interventions which were not hospital based. Smoking cessation guidelines for hospital health professionals were identified via a search of the World Wide Web. The review found that evidence from meta-analyses restricted to hospital studies was insufficient to evaluate a number of specific intervention strategies and at times conflicted with the findings of meta-analyses without such restrictions. The majority of guidelines recommended the provision of brief advice, counseling, nicotine replacement therapy despite the absence of clear supporting evidence. Further hospital-based research addressing specific cessation strategies is required. Furthermore, smoking cessation guidelines for hospital based health professionals should more specifically reflect evidence from this setting.
Publisher: Springer Science and Business Media LLC
Date: 02-2020
Publisher: JMIR Publications Inc.
Date: 25-10-2020
Abstract: here 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. his 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. 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. 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 i P /i =.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 i P /i =.04) and consumed (–117.17 kJ 95% CI –233.72 to –0.62 i P /i =.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. he 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. ustralian Clinical Trials Registry ACTRN12618001731280 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191& isReview=true R2-10.1186/s12889-019-7725-x
Publisher: Springer Science and Business Media LLC
Date: 11-02-2016
Publisher: Springer Science and Business Media LLC
Date: 12-2016
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2017-019151
Abstract: The primary aim for this review is to determine the effectiveness of strategies to improve the implementation of policies, practices or programmes in sporting organisations. The secondary aims are to describe the cost or cost-effectiveness and adverse effects of such strategies and to examine the effects of those implementation strategies on in idual’s diet, physical activity, obesity, alcohol use or tobacco use. We conducted searches of academic databases (eg, MEDLINE, EMBASE and CENTRAL), trial registers and hand searches of selected journals. Studies were included if they were conducted at a sporting venue described a strategy to improve implementation of policies, practices or programmes focusing on one or more health risks (diet, physical inactivity, obesity, alcohol or tobacco use), and included a parallel control group. Two authors independently screened citations and extracted data. The results of included studies were synthesised narratively. Of the 5926 citations screened three studies met the inclusion criteria. Two studies were randomised controlled trials. Two studies sought to improve the implementation of nutrition-related policy and practices and one study sought to improve implementation of alcohol-related policy and practices. Each study reported improvement in at least one measure of policy or practice implementation. Two studies reported in idual-level outcomes and found a reduction in excessive alcohol consumption and an increase in purchase of fruits and vegetables at the sports club ground. Two studies assessed club revenue as a potential adverse effect, neither reported significant between-group differences on these measures. There is a sparse evidence base regarding the effectiveness of strategies to improve the implementation of policies, practices or programmes targeting chronic disease risk factors in sporting clubs. While all studies reported some improvements in implementation, for some multistrategic implementation strategies it is difficult to determine the extent to which such effects are generalisable. CRD42016039490.
Publisher: Wiley
Date: 24-02-2011
Publisher: Wiley
Date: 14-12-2015
DOI: 10.1111/DAR.12362
Abstract: In Australia and New Zealand, population groups who experience social disadvantage smoke at much higher rates than the general population. As there are limited data specific to these groups regarding the success of nicotine replacement therapy for smoking cessation, this commentary will provide an overview of the relevant international literature supplemented with observational data relevant to the policy contexts in Australia and New Zealand. [Paul C, Wolfenden L, Tzelepis F, Yoong S, Bowman J, Wye P, Sherwood E, Rose S, Wiggers J. Nicotine replacement therapy as a smoking cessation aid among disadvantaged smokers: What answers do we need? Drug Alcohol Rev 2016 :785-789].
Publisher: Cambridge University Press (CUP)
Date: 19-11-2012
Publisher: BMJ
Date: 03-03-2014
Publisher: Springer Science and Business Media LLC
Date: 25-10-2015
Publisher: Oxford University Press (OUP)
Date: 16-12-2014
DOI: 10.1093/HER/CYU068
Abstract: Despite significant investment in many countries, the extent of schools' adoption of obesity prevention policies and practices has not been widely reported. The aims of this article are to describe Australian schools' adoption of healthy eating and physical activity policies and practices over an 8-year period and to determine if their adoption varies according to schools' size, geographic or socio-economic location. Between 2006 and 2013, a representative randomly selected cohort of primary schools (n = 476) in New South Wales, Australia, participated in four telephone interviews. Repeated measures logistic regression analyses using a Generalised Estimating Equation (GEE) framework were undertaken to assess change over time. The prevalence of all four of the healthy eating practices and one physical activity practice significantly increased, while the prevalence of one physical activity practice significantly decreased. The adoption of practices did not differ by school characteristics. Government investment can equitably enhance school adoption of some obesity prevention policies and practices on a jurisdiction-wide basis. Additional and/or different implementation strategies may be required to facilitate greater adoption of physical activity practices. Ongoing monitoring of school adoption of school policies and practices is needed to ensure the intended benefits of government investment are achieved.
Publisher: The Sax Institute
Date: 28-01-2016
DOI: 10.17061/PHRP2611604
Abstract: The 'how to' of scaling up public health interventions for maximum reach and outcomes is receiving greater attention however, there remains a paucity of practical tools to guide those actively involved in scaling up processes in high-income countries. To fill this gap, the New South Wales Ministry of Health developed Increasing the scale of population health interventions: a guide (2014). The guide was informed by a systematic review of scaling up models and methods, and a two-round Delphi process with a s le of senior policy makers, practitioners and researchers actively involved in scaling up processes. Although it is a practical guide to assist health policy makers, health practitioners and others responsible for scaling up effective population health interventions, it can also be used by researchers in the design of research studies that are potentially suitable for scaling up, particularly where research-practice collaborations are involved. The guide is ided into four steps: step 1, 'scalability assessment', aims to determine if an intervention is scalable step 2, 'developing a scale up plan', aims to develop a practical and workable scaling up plan that can be used to convince stakeholders there is a compelling case for action. Step 3, 'preparing for scale up', aims to identify ways of securing resources needed for going to scale, operating at scale, and building a foundation of legitimacy and support to sustain the scaling up effort through the implementation stage and step 4, 'scaling up the intervention', involves putting the plan developed in step 2 into place. Although the guide is written as though the user is starting from the point of assessing the scalability of an intervention, later steps can be used by those already involved in scaling up to review their implementation processes. The guide is not intended to be prescriptive. Its purpose is to help policy makers, practitioners, researchers and other decision makers decide on appropriate methodological and practical choices, and balance what is desirable with what is feasible.
Publisher: JMIR Publications Inc.
Date: 22-12-2020
Abstract: here has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of such interventions 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. s such, the aim of this systematic review is to describe the association between DHI engagement (both usage and subjective experience) and dietary intake. comprehensive search for peer-reviewed literature was undertaken in four electronic databases (EMBASE, MEDLINE, PsychINFO, Scopus) from inception to December 2019. A hand search of targeted journals, grey literature searches and a search of relevant references of similar reviews was also 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). Authors single screened studies, with a pair of review authors assessing quality of studies and extracting relevant data. Narrative syntheses using vote counting was undertaken to explore to relationship between measures of engagement and dietary intake. he search resulted in 10,653 citations, of which seven studies (from nine articles) were included in the review. The majority of studies (n=5) included usage measures of engagement rather than subjective experience (n=2). Logins were the most commonly reported usage measure (n=5 studies), and fruit and vegetable intake was the most common measure of dietary intake (n=4 studies). The heterogeneity of engagement and dietary intake measures limited the use of meta-analytic techniques, however narrative review (vote counting) found mixed evidence of an association with usage measures (5 of 12 associations indicating a positive relationship, 7 were inconclusive). No evidence regarding an association with subjective experience was found (0 of 2 associations were inconclusive). The majority of included studies (n=5) were rated poor quality according to the Newcastle Ottawa Scale. he findings provide some evidence supporting an association between measures of usage and fruit and vegetable intake, however this was inconsistent. No evidence was found regarding an association with subjective experience. Given the limited number of studies included in the review and poor quality of available evidence further research examining the association between DHI engagement and dietary intake using consistent measures, with an additional focus on subjective experience is warranted. RD42018112189
Publisher: Wiley
Date: 12-2003
Publisher: Springer Science and Business Media LLC
Date: 27-11-2007
DOI: 10.1007/S12024-007-9011-Y
Abstract: Analysis was undertaken of trends in sudden infant death syndrome (SIDS) in Australia from 1980 to 2002 using Australian Bureau of Statistics data. The results showed a decline in the SIDS mortality rate from an average of 195.6 deaths per 100,000 live births in the period 1980-1990 to an average of 96.5 deaths per 100,000 live births in the period 1991-1996 and 51.7 deaths per 100,000 live births in the period 1997-2002. The Poisson regression coefficients for SIDS fitted to the rates at the Australia level indicated that the Reduce the Risks (RTR) c aign led to a significant decline of almost 40% when contrasting the pre- and post-c aign periods. Despite recent suggestions that the fall in SIDS rate has been due to natural variations in incidence, the data clearly show that the decline in SIDS rates coincided almost immediately with the introduction of the RTR c aign and has been sustained over time. There was no evidence of diagnostic transfer or of a postponement of death from infancy to early childhood years. Unless this dramatic fall was caused by as yet undetected factors, the c aign is the only plausible explanation for the markedly reduced SIDS rate in Australia.
Publisher: JMIR Publications Inc.
Date: 22-12-2018
Abstract: ffectively 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. he 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school ch ions (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 ch ions using mixed methods. he 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 ch ions (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. or the first objective, in-school ch ions 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. igital 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. ustralian New Zealand Clinical Trials Registry ACTRN12617000681358 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870
Publisher: Oxford University Press (OUP)
Date: 26-02-2014
Publisher: Wiley
Date: 16-01-2014
Publisher: Elsevier BV
Date: 09-2015
Publisher: Elsevier BV
Date: 07-2005
DOI: 10.1016/J.YPMED.2004.11.011
Abstract: Evidence suggests that preoperative clinics, like other hospital outpatient clinics and inpatient wards, fail to systematically provide smoking cessation care to patients having planned surgery. The aim of the study was to assess the efficacy, acceptability, and cost of a multifaceted intervention to facilitate the provision of comprehensive smoking cessation care to patients attending a preoperative clinic. Two hundred ten smoking patients attending a preoperative clinic at a major teaching hospital in Australia took part in the study. One hundred twenty-four patients were randomly assigned to an experimental group and 86 patients to a usual cessation care group. A multifaceted intervention was developed that included the use of opinion leaders, consensus processes, computer-delivered cessation care, computer-generated prompts for care provision by clinic staff, staff training, and performance feedback. Ninety-six percent of experimental group patients received behavioral counseling and tailored self-help material. Experimental group patients were significantly more likely than usual care patients to report receiving brief advice by nursing (79% vs. 47% P < 0.01) and anaesthetic (60% vs. 39% P < 0.01) staff. Experimental group patients who were nicotine dependent were also more likely to be offered preoperative nicotine replacement therapy (NRT) (82% vs. 8% P < 0.01) and be prescribed postoperative NRT (86% vs. 0% P < 0.01). The multifaceted intervention was found to be acceptable by staff. A multifaceted clinical practice change intervention may be effective in improving the delivery of smoking cessation care to preoperative surgical patients.
Publisher: BMJ
Date: 25-02-2015
Publisher: BMJ
Date: 11-2016
Publisher: Elsevier BV
Date: 02-2017
Abstract: To describe the price of Australian school canteen foods according to their nutritional value. Primary school canteen menus were collected as part of a policy compliance randomised trial. For each menu item, dietitians classified its nutritional value 'green' ('good sources of nutrients'), 'amber' ('some nutritional value'), 'red' ('lack adequate nutritional value') and assigned a food category (e.g. 'Drinks', 'Snacks'). Pricing information was extracted. Within each food category, ANOVAs assessed differences between the mean price of 'green', 'amber' and 'red' items, and post-hoc tests were conducted. Seventy of the 124 invited schools participated. There were significant differences in the mean price of 'green', 'amber' and 'red foods' across categories, with 'green' items more expensive than 'amber' items in main-meal categories ('Sandwiches' +$0.43, 'Hot Foods' +$0.71), and the reverse true for non-meal categories ('Drinks' -$0.13, 'Snacks' -$0.18, 'Frozen Snacks' -$0.25^). Current pricing may not encourage the purchasing of healthy main-meal items by and for students. Further investigation of pricing strategies that enhance the public health benefit of existing school canteen policies and practices are warranted. Implications for Public Health: Providing support to canteen managers regarding healthy canteen policies may have a positive impact on public health nutrition.
Publisher: JMIR Publications Inc.
Date: 17-03-2022
DOI: 10.2196/27760
Abstract: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18 P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90 P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Australian New Zealand Clinical Trials Registry ACTRN12618000133235 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379
Publisher: BMJ
Date: 09-2015
Publisher: Elsevier BV
Date: 2014
DOI: 10.1016/J.YPMED.2013.10.004
Abstract: To evaluate the impact of a multi-level intervention on the physical activity levels of 3-5 year old children attending center-based childcare services. The trial was conducted in New South Wales Australia in 2010 in 20 centers with 459 children. The intervention, included: fundamental movement skill sessions structured activities staff role modelling limiting small screen recreation and sedentary time and anactivity promoting physical environment. Control services continued with usual routines. Physical activity during care was assessed using pedometers at baseline and at six months after baseline. Intervention implementation was assessed via observation of staff physical activity practices and audits of service environment and policy. Mean step counts at baseline and follow-up were 17.20 (CI 15.94-18.46) and 16.12 (CI 14.86-17.30) in the intervention group and 13.78 (CI 12.76-14.80) and 13.87 (CI 12.57-15.17) in the control group (p=0.12). Intervention services showed significantly greater increases in the total minutes that teachers led structured activities, relative to control group services (p=0.02). The intervention showed no significant effect on child step counts per minute despite increasing time that staff delivered structured activity which is likely to be attributable to difficulties experienced by service staff in delivering a number of intervention components.
Publisher: Oxford University Press (OUP)
Date: 06-2008
DOI: 10.1080/14622200802097472
Abstract: The aim of the study was to assess the feasibility, acceptability, and cost of referral of smoking patients to a proactive quitline service for postdischarge cessation support. Participants were recruited from the preoperative clinic of an Australian hospital. Data were collected from project records and a telephone interview with participants 6 months after attending the preoperative clinic. The study found that 64% of the 67 participants accepted an offer of referral to the quitline by preoperative clinic staff. Some 74% of patients referred to the quitline were contacted by the quitline after discharge. Smokers contacted by the quitline and clinic staff referring patients to the quitline generally responded favorably on items assessing the acceptability of the quitline service and the process of referral to the quitline. Referral to the quitline service cost less than US$2 per patient. Referral of patients to a quitline is feasible, was generally considered acceptable by surgical patients and staff, and was inexpensive.
Publisher: Wiley
Date: 17-07-2019
DOI: 10.1111/OBR.12872
Abstract: Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.
Publisher: Elsevier BV
Date: 06-2016
Publisher: Springer Science and Business Media LLC
Date: 08-04-2013
Abstract: Consumption of non-core foods in childhood is associated with excessive weight gain in childhood. Parents play a vital role in establishing healthy diet behaviours in young children. The aim of this study was to assess the effectiveness of a telephone-based intervention in reducing child consumption of non-core foods, and to examine parent and home food environment mediators of change in child consumption. The ‘Healthy Habits’ trial utilised a clustered randomised controlled design. Parents were recruited from 30 preschools (N = 394 participants, mean age 35.2±5.6 years). Parents randomized to the intervention group received four telephone contacts and print materials. Parents allocated to the control condition receive generic print materials only. Non-core food consumption was assessed using a validated child dietary questionnaire at baseline, 2 and 6 months post recruitment in 2010. The intervention was effective in reducing child consumption of non-core foods at 2 months (intention to treat analysis: z=-2.83, p .01), however this effect was not maintained at 6 months. Structural equation modelling using 2 month data indicated that child access to non-core foods in the home and child feeding strategies mediated the effect of the intervention. The telephone-based intervention shows promise in improving short term dietary behaviour in preschool age children, however further development is needed to sustain the effect in the long-term. Australian Clinical Trials Registry: ACTRN12609000820202
Publisher: Wiley
Date: 10-01-2005
DOI: 10.1111/J.1365-2044.2004.04070.X
Abstract: We assessed the efficacy of a comprehensive programme for stopping smoking in 210 smokers scheduled for surgery, before admission and 3 months after attending a pre-operative clinic. Participants were randomly allocated to receive an intervention incorporating nicotine replacement therapy for patients smoking more than 10 cigarettes per day ("dependent smokers"), or to a control group to receive usual care. Dependent smokers allocated to the intervention group were more likely to report abstinence before surgery than those allocated to receive usual-care (63 (73%) vs. 29 (56%), respectively OR 2.2 (95% CI 1.0-4.8)), and 3 months after attendance (16 (18%) vs. 3 (5%), respectively OR = 3.9 (95% CI 1.0-21.7).
Publisher: JMIR Publications Inc.
Date: 30-05-2017
DOI: 10.2196/MENTAL.7435
Abstract: eHealth presents opportunities to provide population groups with accessible health interventions, although knowledge about Internet access, peoples’ interest in using the Internet for health, and users’ characteristics are required prior to eHealth program development. This study surveyed hospital patients to examine rates of Internet use, interest in using the Internet for health, and respondent characteristics related to Internet use and interest in using the Internet for health. For patients who smoke, preferences for types of smoking cessation programs for use at home and while in hospital were also examined. An online cross-sectional survey was used to survey 819 orthopedic trauma patients (response rate: 72.61%, 819/1128) from two public hospitals in New South Wales, Australia. Logistic regressions were used to examine associations between variables. A total of 72.7% (574/790) of respondents had at least weekly Internet access and more than half (56.6%, 357/631) reported interest in using the Internet for health. Odds of at least weekly Internet usage were higher if the in idual was born overseas (OR 2.21, 95% CI 1.27-3.82, P=.005), had a tertiary education (OR 3.75, 95% CI 2.41-5.84, P .001), or was a nonsmoker (OR 3.75, 95% CI 2.41-5.84, P .001). Interest in using the Internet for health increased with high school (OR 1.85, 95% CI 1.09-3.15, P=.02) or tertiary education (OR 2.48, 95% CI 1.66-3.70, P .001), and if household incomes were more than AUS $100,000 (OR 2.5, 95% CI 1.25-4.97, P=.009). Older in iduals were less interested in using the Internet for health (OR 0.98, 95% CI 0.97-0.99, P .001). Online interventions may be a potential tool for health care in this hospitalized population. Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001147673 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366829& isReview=true (Archived by WebCite at qg26u3En)
Publisher: Elsevier BV
Date: 12-2016
Publisher: JMIR Publications Inc.
Date: 15-12-2021
DOI: 10.2196/25902
Abstract: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates) examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies understand the potential cost of delivering and receiving implementation support strategies and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 RR2-10.1186/s40814-020-00707-w
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1111/J.1753-6405.2009.00387.X
Abstract: Schools increasingly require researchers to obtain active parental consent for students to participate in health research. We sought to identify effective strategies for the recruitment of child research participants through schools. A search of Medline, PsycINFO, Educational Resources Information Center, ProQuest 5000 and the Cochrane Library electronic databases was conducted for the period 1988 to 2008. The review found evidence that the following strategies may be effective in enhancing participation rates: 1) promotion of the research to school principals, teachers, parents and students 2) dissemination of study information using methods allowing direct contact with parents (i.e. telephone or face-to-face) 3) provision of incentives to teachers, students and at a class level 4) making reminder contacts and 5) having a member of the research team co-ordinate and closely monitor the recruitment process. Application of these strategies should reduce the risk of non-response and other biases that result from selective non-participation. Further randomised controlled trials of these and other strategies are required to strengthen the evidence base.
Publisher: Springer Science and Business Media LLC
Date: 06-05-2013
Publisher: Wiley
Date: 06-12-2019
DOI: 10.1002/HPJA.310
Abstract: Healthy canteen policies regulating the sales of food and beverages are available across all the states and territories in Australia. The aim of this study was to assess the compliance with a newly updated healthy school canteen policy in New South Wales (NSW) among a s le of secondary schools. A cross-sectional study of secondary school canteen menus was undertaken in selected regions across NSW (September 2017-November 2017). Government and Catholic secondary schools with a canteen menu publicly available on school websites were eligible for inclusion. Menus were classified according to the NSW Healthy School Canteen Strategy using a Quick Menu Audit tool, previously validated in primary schools. Of 62 Catholic and 128 Government secondary schools located in the study region, 53 secondary schools (25 Catholic and 28 Government) were eligible to participate. The average percentage of "everyday" (healthy) items on secondary school menus was 54% (strategy criteria is >75%). Twenty-eight per cent of menus had no "sugary drinks" (should not be sold). None of the 53 menus assessed met all strategy criteria regarding the availability of foods and beverages. There was no statistically significant difference in meeting (a) 75% minimum "everyday" items and (b) no "sugary drinks," by socio-economic region, remoteness, school enrolments or school type. If public health benefits of healthy eating policies are to be realised, secondary schools need to be supported to implement such policies. SO WHAT?: Future research assessing the impact of intervention strategies to support policy implementation in secondary schools is recommended.
Publisher: Wiley
Date: 21-05-2015
DOI: 10.1071/HE14098
Publisher: JMIR Publications Inc.
Date: 02-12-2019
Abstract: nowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. his study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in in idual or population health outcomes. search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. f the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on in idual or population-level health outcomes. his review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.
Publisher: Oxford University Press (OUP)
Date: 13-05-2015
Publisher: Elsevier BV
Date: 06-2015
Abstract: Community sports clubs provide an important contribution to the health and wellbeing of in iduals and the community however, they have also been associated with risky alcohol consumption. This study assessed whether a club's alcohol management strategies were related to risky alcohol consumption by members and levels of social capital, as measured in terms of participation in and perceived safety of the club. A total of 723 sports club members from 33 community football clubs in New South Wales, Australia, completed a computer assisted telephone interview (CATI) and a management representative from each club also completed a CATI. The club representative reported on the club's implementation of 11 alcohol management practices, while club members reported their alcohol consumption and perceived levels of safety at the club and participation in the club. A structural equation model identified having the bar open for more than four hours having alcohol promotions and serving intoxicated patrons were associated with increased risky alcohol consumption while at the club which in turn was associated with lower levels of perceived club safety and member participation. The positive contribution of community sports clubs to the community may be diminished by specific inadequate alcohol management practices. Changing alcohol management practices can reduce alcohol consumption, and possibly increase perceived aspects of social capital, such as safety and participation.
Publisher: Wiley
Date: 26-06-2015
Publisher: Elsevier BV
Date: 08-2007
Publisher: BMJ
Date: 2018
Publisher: BMJ
Date: 21-05-2015
Publisher: Springer Science and Business Media LLC
Date: 08-09-2010
Publisher: Wiley
Date: 19-12-2016
Publisher: Informa UK Limited
Date: 05-2011
Publisher: Elsevier BV
Date: 06-2013
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2013
Publisher: Springer Science and Business Media LLC
Date: 21-11-2012
DOI: 10.1186/1471-2458-12-1009
Abstract: Whilst schools provide a potentially appropriate setting for preventing substance use among young people, systematic review evidence suggests that past interventions in this setting have demonstrated limited effectiveness in preventing tobacco, alcohol and other drug use. Interventions that adopt a mental wellbeing approach to prevent substance use offer considerable promise and resilience theory provides one method to impact on adolescent mental well-being. The aim of the proposed study is to examine the efficacy of a resilience intervention in decreasing the tobacco, alcohol and illicit drug use of adolescents. A cluster randomised controlled trial with schools as the unit of randomisation will be undertaken. Thirty two schools in disadvantaged areas will be allocated to either an intervention or a control group. A comprehensive resilience intervention will be implemented, inclusive of explicit program adoption strategies. Baseline surveys will be conducted with students in Grade 7 in both groups and again three years later when the student cohort is in Grade 10. The primary outcome measures will include self-reported tobacco, alcohol, marijuana and other illicit drug use. Comparisons will be made post-test between Grade 10 students in intervention and control schools to determine intervention effectiveness across all measures. To the authors’ knowledge this is the first randomised controlled trial to evaluate the effectiveness of a comprehensive school-based resilience intervention, inclusive of explicit adoption strategies, in decreasing tobacco, alcohol and illicit drug use of adolescents attending disadvantaged secondary schools. ACTRN12611000606987
Publisher: JMIR Publications Inc.
Date: 30-04-2015
DOI: 10.2196/JMIR.3639
Publisher: JMIR Publications Inc.
Date: 07-09-2021
DOI: 10.2196/26054
Abstract: 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. 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. 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. 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. 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. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. RR2-10.1136/bmjopen-2019-030538
Publisher: Elsevier BV
Date: 05-2016
Publisher: Elsevier BV
Date: 05-2016
DOI: 10.1016/J.YPMED.2015.11.018
Abstract: To examine elementary school students' moderate-to-vigorous physical activity (MVPA) levels during physical education (PE) lessons. A systematic search of nine electronic databases was conducted (PROSPERO2014:CRD42014009649). Studies were eligible if they were in English published between 2005-April 2014 assessed MVPA levels in PE lessons of elementary school children (aged four-12years) and used an objective MVPA measure. Two reviewers retrieved articles, assessed risk of bias, and performed data extraction. The findings were synthesised using a meta-analysis. The search yielded 5132 articles. Thirteen studies from nine countries met the inclusion criteria. Eight studies measured MVPA through observational measures, five used accelerometry and one used heart rate monitoring. The percentage of PE lesson time spent in MVPA ranged between 11.4-88.5%. Meta-analysis of seven studies (4 direct observations 4 accelerometers) found that children spent a mean (95% CI) 44.8 (28.2-61.4)% of PE lesson time in MVPA. When measured using direct observation and accelerometers, children spent 57.6 (47.3-68.2) and 32.6 (5.9-59.3)% of PE lesson time in MVPA, respectively. The review has limitations the search strategy was restricted to studies in English theses, dissertations and conference abstracts were excluded and six studies that provided insufficient data were excluded from the meta-analysis. MVPA levels during elementary school PE lessons do not meet the United States Centre for Disease Control and Prevention and the United Kingdom's Association of Physical Education recommendation (50% of lesson time), but is higher than estimated in the previous review (34.2%). Interventions to increase MVPA in PE lessons are needed.
Publisher: Wiley
Date: 16-09-2016
DOI: 10.1071/HE16053
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.DRUGPO.2014.05.001
Abstract: In 2005 a Bill was introduced to the New Zealand parliament to increase the alcohol minimum purchasing age (MPA) from 18 to 20 years and submissions were invited from interested parties. We sought to characterise and critique the arguments tendered for and against the proposal. We used template analysis to study written submissions on the Bill from 178 people and organisations in New Zealand. Independent raters coded submissions according to the source, whether for or opposed, and the arguments employed. The most common sources of submissions were members of the public (28%), the alcohol industry (20%), and NGOs (20%). Overall, 40% opposed increasing the MPA, 40% were in favour, 4% supported a split MPA (18 years for on-premise, 20 years for off-premise), 7% were equivocal, and 8% offered no comment. The most common proponents of increasing the MPA were NGOs (36%) and members of the public (30%) and their arguments concerned the expected positive effects on public health (36%) and public disorder roperty damage (16%), while 24% argued that other strategies should be used as well. The most common sources of opposition to increasing the MPA were the alcohol industry (50%) and the public (20%). It was commonly claimed that the proposed law change would be ineffective in reducing harm (22%), that other strategies should be used instead (16%), that it would infringe adult rights (15%), and that licensed premises are safe environments for young people (14%). There were noteworthy ex les of NGOs and government agencies opposing the law change. The alcohol industry maximised its impact via multiple submissions appealing to in idual rights while neglecting to report or accurately characterise the scientific evidence. Several health and welfare agencies presented confused logic and/or were selective in their use of scientific evidence. In contrast to the fragmented and inconsistent response from government and NGOs, the alcohol industry was organised and united, with multiple submissions from the sector with most at stake, namely the hospitality industry, and supporting submissions from the manufacturing, import, and wholesale sectors. Systematic reviews of research evidence should be routinely undertaken to guide the legislature and submissions should be categorised on the basis of pecuniary interest.
Publisher: JMIR Publications Inc.
Date: 04-08-2020
Abstract: he 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. his 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). our 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 s led or recruited in iduals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the in idual 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. verall, 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). he 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.
Publisher: JMIR Publications Inc.
Date: 05-12-2021
Abstract: igh school canteens are a recommended setting for public health nutrition intervention. The rapid uptake of online lunch ordering within school canteens provides a unique opportunity to support the purchase healthier lunch items via the use of choice architecture strategies. Despite this, no trial has tested the efficacy of choice architecture strategies within an online lunch ordering system on improving the nutritional quality of high school student lunch purchases. o assess the impact of embedding choice architecture strategies into an online lunch ordering system (menu labelling, prompts, item positioning, and feedback) on the nutritional quality of the school canteen lunch purchases of high school students (aged 12-19 years). cluster randomized controlled trial was conducted with nine high schools in one Australian state. Schools were randomized to receive either the choice architecture intervention, or usual online ordering. Nutrient quality was assessed using routine data collected by the online ordering system. Primary outcomes were the proportion of ‘Everyday’, ‘Occasional’, and ‘Should Not Be Sold’ items purchased, categorized using the state healthy canteen policy. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Linear mixed models were analyzed to assess outcomes. here were significant between group differences over time for the intervention group for the mean percentage of online lunch items per student that were ‘Everyday’ (+5.5% [95% CI 2.2, 8.9] P .001) and ‘Should Not Be Sold’ (-4.4% [95% CI -7.0, -1.8] P .001). There were no between group differences over time in the mean percentage of online lunch items that were ‘Occasional’ or the average energy, saturated fat, sugar, or sodium content of lunch orders. hese findings suggest that a low intensity, choice architecture intervention embedded within an online ordering system can increase the purchase of healthier food items for high school students. his trial was prospectively registered on Open Science Framework on 23rd October 2020 as osf.io/h8zfr.
Publisher: BMJ
Date: 2018
DOI: 10.1136/BMJOPEN-2017-018906
Abstract: A large proportion of children and adolescents participate in organised sport, making community sports clubs a promising setting to support healthy behaviours. To date, however, there have been few interventions conducted in junior sports clubs that have targeted health-promoting practices. The primary aim of this pilot study is to assess the potential effectiveness of an intervention to implement health-promoting policies and practices in junior sporting clubs targeting alcohol and tobacco practices, healthy food and beverage availability, and physical activity via participation in sport. A secondary outcome is to assess the impact of such strategies on child exposure to alcohol and tobacco use at the club, purchasing behaviours by/for children at the club canteen and child sports participation opportunities. The study will employ a cluster randomised controlled trial design and be conducted in metropolitan and regional areas of two Australian states. Randomisation will occur at the level of the football league. Community football clubs with over 40 junior players (players under 18 years) within each league will be eligible to participate. The intervention will be developed based on frameworks that consider the social, cultural and environmental factors that influence health behaviours. Intervention clubs will be supported to implement 16 practices targeting alcohol management, tobacco use, nutrition practices, new player recruitment activity, equal participation for players and the development of policies to support these practices. Trained research staff will collect outcome data via telephone interviews at baseline and follow-up. Interviews will be conducted with both club representatives and parents of junior players. The study has been approved by the University of Newcastle Human Research Ethics Committee (H-2013-0429). The results of the study will be disseminated via peer-reviewed publications and presentations at conferences. ACTRN12617001044314 Pre-results.
Publisher: Wiley
Date: 29-09-2016
DOI: 10.1071/HE16056
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.YPMED.2016.06.012
Abstract: Growing evidence points to the benefits of addressing multiple health behaviors rather than single behaviors. This review evaluates the relative effectiveness of simultaneous and sequentially delivered multiple health behavior change (MHBC) interventions. Secondary aims were to identify: a) the most effective spacing of sequentially delivered components b) differences in efficacy of MHBC interventions for adoption/cessation behaviors and lifestyle/addictive behaviors, and c) differences in trial retention between simultaneously and sequentially delivered interventions. MHBC intervention trials published up to October 2015 were identified through a systematic search. Eligible trials were randomised controlled trials that directly compared simultaneous and sequential delivery of a MHBC intervention. A narrative synthesis was undertaken. Six trials met the inclusion criteria and across these trials the behaviors targeted were smoking, diet, physical activity, and alcohol consumption. Three trials reported a difference in intervention effect between a sequential and simultaneous approach in at least one behavioral outcome. Of these, two trials favoured a sequential approach on smoking. One trial favoured a simultaneous approach on fat intake. There was no difference in retention between sequential and simultaneous approaches. There is limited evidence regarding the relative effectiveness of sequential and simultaneous approaches. Given only three of the six trials observed a difference in intervention effectiveness for one health behavior outcome, and the relatively consistent finding that the sequential and simultaneous approaches were more effective than a usual/minimal care control condition, it appears that both approaches should be considered equally efficacious. PROSPERO registration number: CRD42015027876.
Publisher: Springer Science and Business Media LLC
Date: 02-09-2016
Publisher: Elsevier BV
Date: 2015
Publisher: Elsevier BV
Date: 06-2012
Publisher: Cambridge University Press (CUP)
Date: 12-03-2021
Publisher: BMJ
Date: 06-2015
Publisher: Oxford University Press (OUP)
Date: 24-04-2007
Abstract: Despite increased risks of postoperative complications among patients who use tobacco, a number of barriers hinder the systematic identification of surgical patients who smoke. The study investigated the accuracy and acceptability of a patient-completed touchscreen computer program, which assessed patient smoking status during attendance at a surgical pre-operative clinic. One thousand and four patients participated in the study and completed a touchscreen computer smoking assessment program. The sensitivity and specificity measures of the computerized assessment were 93% and 95% respectively. Patients, and clinic receptionists, nurses and anaesthetists found the touchscreen computer-based assessment acceptable. The findings suggest that computerized assessment of smoking status is an accurate and acceptable way to identify tobacco users in a pre-operative clinic setting.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Springer Science and Business Media LLC
Date: 02-03-2016
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1111/J.1753-6405.2011.00773.X
Abstract: To describe, based on routinely recorded police data, the prevalence and characteristics of alcohol consumption among people involved in violence and disorder incidents in non-metropolitan New South Wales (NSW). A descriptive analysis was conducted of people involved in violence and disorder incidents over 24 months (2003-05) across 21 non-metropolitan police commands. The prevalence of alcohol involvement was reported as: the annual population rate of people involved in incidents who had consumed alcohol the proportion of people involved in such incidents who had consumed alcohol and the proportion of such people who were intoxicated. Variation in alcohol involvement was described by: geographic area day of week time of day and location alcohol was last consumed. Annually, one in 118 people in the population consumed alcohol prior to involvement in a violence incident, and one in 476 people did so prior to a disorder incident. At least 71% of such people were intoxicated. Late Saturday evening was the peak time for alcohol involvement. Prior drinking in private residences and licensed premises was associated with violence and disorder incidents (respectively). The prevalence of alcohol consumption rose with increased geographic remoteness. All characteristics displayed geographic variation. The high prevalence of alcohol consumption, particularly intoxication, in violence and disorder incidents represents a significant public health issue for non-metropolitan NSW. Geographic variability in the prevalence and characteristics of alcohol-related crime suggests a need for locally targeted, yet evidence-based, interventions to reduce such harm.
Publisher: JMIR Publications Inc.
Date: 20-11-2020
DOI: 10.2196/22036
Abstract: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. This study aimed to assess in a national s le of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly s led from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived in idual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P .001) and identifying work and in iduals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.
Publisher: Wiley
Date: 25-04-2016
DOI: 10.1002/OBY.21459
Abstract: This review aimed to examine the impact of interventions involving an explicit sleep component on child body mass index (BMI), diet, and physical activity. A systematic search was undertaken in six databases to identify randomized controlled trials examining the impact of interventions with a sleep component on child BMI, dietary intake, and/or physical activity. A random effects meta-analysis was conducted assessing the impact of included interventions on child BMI. Of the eight included trials, three enforced a sleep protocol and five targeted sleep as part of multicomponent behavioral interventions either exclusively or together with nutrition and physical activity. Meta-analysis of three studies found that multicomponent behavioral interventions involving a sleep component were not significantly effective in changing child BMI (n = 360,-0.04 kg/m(2) [-0.18, 0.11], I(2) = 0%) however, only one study included in the meta-analysis successfully changed sleep duration in children. There were some reported improvements to adolescent diet, and only one trial examined the impact on child physical activity, where a significant effect was observed. Findings from the included studies suggest that where improvements in child sleep duration were achieved, a positive impact on child BMI, nutrition, and physical activity was also observed.
Publisher: BMJ
Date: 08-2017
DOI: 10.1136/BMJOPEN-2017-016060
Abstract: Initiation of tobacco, alcohol and illicit substance use typically occurs during adolescence, with the school setting recommended to reduce adolescent substance use. Strengthening in idual (eg, problem solving) and environmental (eg, caring relationships at school) resilience protective factors of adolescents has been suggested as a strategy for reducing substance use by adolescents however, few studies have examined this potential. A study was conducted to investigate the effectiveness of a pragmatic school-based universal ‘resilience’ intervention in reducing the prevalence of tobacco, alcohol and illicit substance use, and increasing the in idual and environmental protective factors of students. A cluster-randomised controlled trial. Thirty-two Australian secondary schools (20 intervention 12 control). Cohort of grade 7 students followed-up in grade 10 (2014 aged 15–16 years). A pragmatic intervention involving school staff selection and implementation of available programmes and resources targeting in idual and environmental ‘resilience’ protective factors for all grade 7–10 students was implemented in schools (2012–2014). School staff were provided implementation support. An online survey collected baseline and follow-up data for primary outcomes: tobacco (ever, recent) and alcohol (ever, recent, ‘risk’) use, and secondary outcomes: marijuana and other illicit substance use, and in idual (six-factor subscales, aggregate) and environmental (three-factor subscales, aggregate) protective factor scores. Generalised and linear mixed models examined follow-up differences between groups. Follow-up data from 2105 students (intervention=1261 control=844 69% of baseline cohort) were analysed. No significant differences were found between intervention and control students for any primary (ever tobacco: OR 1.25, 95% CI 0.92 to 1.68, p=0.14 recent tobacco: OR 1.39, 95% CI 0.84 to 2.31, p=0.19 recent ever alcohol: OR 1.11, 95% CI 0.83 to 1.48, p=0.46 alcohol: OR 1.13, 95% CI 0.78 to 1.62, p=0.51 ‘risk’ alcohol: OR 0.98, 95% CI 0.70 to 1.36, p=0.89) or secondary outcomes (marijuana: OR 1.12, 95% CI 0.74 to 1.68, p=0.57 other illicit substance: OR 1.19, 95% CI 0.67 to 2.10, p=0.54 in idual protective factors: MD=0, 95% CI −0.07 to 0.06, p=0.89 environmental protective factors: MD: −0.02, 95% CI −0.09 to 0.06, p=0.65). The universally implemented pragmatic school-based intervention was not effective in reducing the prevalence of tobacco, alcohol or illicit substance use, or in increasing the protective factors of students. Australia and New Zealand Clinical Trials Register reference: ACTRN12611000606987
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.AMEPRE.2014.08.003
Abstract: People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision.
Publisher: F1000 Research Ltd
Date: 25-01-2023
DOI: 10.12688/HRBOPENRES.13675.1
Abstract: Although there are effective evidence-based interventions (EBIs) to prevent, treat and coordinate care for chronic conditions they may not be adopted widely and when adopted, implementation challenges can limit their impact. Implementation strategies are “methods or techniques used to enhance the adoption, implementation, and sustainment of a clinical program or practice”. There is some evidence to suggest that to be more effective, strategies should be tailored that is, selected and designed to address specific determinants which may influence implementation in a given context. Despite the growing popularity of tailoring the concept is ill-defined, and the way in which tailoring is applied can vary across studies or lack detail when reported. There has been less focus on the part of tailoring where stakeholders prioritise determinants and select strategies, and the way in which theory, evidence and stakeholders’ perspectives should be combined to make decisions during the process. Typically, tailoring is evaluated based on the effectiveness of the tailored strategy , we do not have a clear sense of the mechanisms through which tailoring works, or how to measure the “success” of the tailoring process. We lack an understanding of how stakeholders can be involved effectively in tailoring and the influence of different approaches on the outcome of tailoring. Our research programme, CUSTOMISE (Comparing and Understanding Tailoring Methods for Implementation Strategies in healthcare) will address some of these outstanding questions and generate evidence on the feasibility, acceptability, and efficiency of different tailoring approaches, and build capacity in implementation science in Ireland, developing and delivering training and supports for, and network of, researchers and implementation practitioners. The evidence generated across the studies conducted as part of CUSTOMISE will bring greater clarity, consistency, coherence, and transparency to tailoring, a key process in implementation science.
Publisher: BMJ
Date: 18-01-2021
DOI: 10.1136/BMJ.M3721
Publisher: Springer Science and Business Media LLC
Date: 13-06-2015
Publisher: Springer Science and Business Media LLC
Date: 11-10-2014
Publisher: Cambridge University Press (CUP)
Date: 23-06-2011
DOI: 10.1017/S1368980011001170
Abstract: To examine the potential efficacy of a brief telephone-based parental intervention in increasing fruit and vegetable consumption in children aged 3–5 years and to examine the feasibility of intervention delivery and acceptability to parents. A pre–post study design with no comparison group. Telephone surveys were conducted approximately 1 week before and following intervention delivery. Participants were recruited through pre-schools in the Hunter region, New South Wales, Australia. Thirty-four parents of 3–5-year-olds received four 30-min interventional telephone calls over 4 weeks administered by trained telephone interviewers. The scripted support calls focused on fruit and vegetable availability and accessibility within the home, parental role modelling of fruit and vegetable consumption and on implementing supportive family eating routines. Following the intervention, the frequency and variety of fruit and vegetable consumption increased ( P = 0·027), as measured by a subscale of the children's dietary questionnaire. The intervention was feasible to be delivered to parents, as all participants who started the intervention completed all four calls, and all aspects of the interventional calls, including the number, length, content, format and relevance, were considered acceptable by more than 90 % of parents. A brief telephone-based parental intervention to encourage fruit and vegetable consumption in pre-school-aged children may be effective, feasible and acceptable. Further investigation is warranted in a randomised controlled trial.
Publisher: Elsevier BV
Date: 07-2012
Publisher: JMIR Publications Inc.
Date: 03-12-2020
Abstract: nternationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. he broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates) examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies understand the potential cost of delivering and receiving implementation support strategies and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. f the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). his study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 R2-10.1186/s40814-020-00707-w
Publisher: Springer Science and Business Media LLC
Date: 17-09-2015
Publisher: BMJ
Date: 20-11-2013
Publisher: JMIR Publications Inc.
Date: 06-02-2021
Abstract: nterventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. his study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. ata on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18 i P /i =.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90 i P /i =.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). he intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. ustralian New Zealand Clinical Trials Registry ACTRN12618000133235 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379
Publisher: Springer Science and Business Media LLC
Date: 07-10-2016
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JSAT.2016.05.006
Abstract: People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services. A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined. Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas. Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.
Publisher: Elsevier BV
Date: 12-2010
Publisher: Oxford University Press (OUP)
Date: 09-04-2016
Abstract: The aim of this short report was to describe the output and citation rates of public health. Data-based publications and literature reviews from the year 2008, and their 5-year citation rates were extracted from 10 randomly selected public health journals. In total, 86.2% of publications were descriptive/epidemiological studies, 56.8% used cross-sectional (56.8%) designs and 77.8% were classified as research translation stage 2. Reviews and publications describing randomized controlled trials were the most highly cited, but were infrequently published. Strategies to address the discordance between public health research output and research citation may improve the impact of public health research.
Publisher: Elsevier BV
Date: 02-2008
Publisher: Wiley
Date: 03-07-2014
DOI: 10.1071/HE13089
Publisher: Wiley
Date: 11-03-2019
DOI: 10.1002/HPJA.238
Abstract: School-based nutrition policies can have a positive effect on the school food environment. The primary aim of this study was to assess the primary school adherence to a mandatory state-wide healthy canteen policy 12 months after an effective multi-strategic implementation intervention concluded. Primary schools were randomised to (a) a 12-14 months multi-strategic intervention or (b) no-intervention (control). The intervention aimed to improve implementation of a state-wide canteen policy by encouraging schools to remove unhealthy food and beverages (classified as ''red'' or ''banned'') from canteen menus and replace with healthy items (classified as ''green''). No implementation support was provided to either group by the research team between the 12 and 24 months data collection period. Seventy schools participated, of which 56 schools were assessed at 24-month follow-up. Intervention schools were less likely to have a menu which contained ''red/banned'' items at 24-month follow-up (RR = 2.28 95% CI: 1.18-4.40 P = 0.01). Intervention schools, however, were not more likely than controls to have a menu which contained >50% ''green'' items at 24-month follow-up (RR = 1.29 95% CI: 0.98-1.70 P = 0.10). Intervention schools were more likely to adhere to both policy components (no red/banned items and >50% green items on the menu) than control schools (RR = 2.61 95% CI: 1.29-5.29 P = 0.006). Among intervention schools that were fully adherent to the policy following implementation support (12-month post baseline), all were also adherent at the 24-month follow-up. The intervention was effective in achieving long-term school adherence to a state-wide canteen policy at 24-month follow-up. SO WHAT?: The findings suggest that sustained improvements in implementation of school nutrition policies is possible following a period (12 months) of comprehensive implementation support.
Publisher: Wiley
Date: 13-05-2020
DOI: 10.1002/HPJA.357
Abstract: Lowering the rates of adolescent overweight and obesity is a public health priority. The implementation of nutrition policies and practices in schools is recommended by various health organisations, but there is little information on the extent of their implementation. The aim of this study is to describe the prevalence of the implementation of recommended school‐level nutrition policies and practices in secondary schools in New South Wales (NSW), Australia, and reported barriers and facilitators to the adoption of such policies and practices in school plans. A cross‐sectional study was undertaken with school principals and canteen managers. All eligible secondary schools in NSW were approached to participate in a telephone survey (n = 440). Descriptive statistics were used to describe prevalence, and associations between school characteristics and implementation were examined using univariate statistics. A total of 137 school principals and 80 canteen managers completed the survey. The implementation of practices on drinking water during class, healthy food and beverage marketing and learning opportunities regarding healthy eating was high ( % of participating schools). The implementation of practices regarding the restriction of unhealthy drinks in school canteens, healthy school fundraisers and staff training related to healthy eating was reported in under 25% of participating schools. There were no significant differences in implementation by school sector, socio‐economic status and geographic location. The main barrier to inclusion of nutrition policies and practices in the school plan was having other priorities and commitments (28.5%), and the main facilitator was support from stakeholders, the staff, students and their parents (37.2%). There is opportunity to improve the implementation of nutrition policies and practices in NSW secondary schools. Strategies are needed for targeting barriers. These include: gaining support from school staff, students and parents, provision of resources and funding and staff training.
Publisher: Springer Science and Business Media LLC
Date: 14-04-2016
Publisher: JMIR Publications Inc.
Date: 29-11-2021
DOI: 10.2196/31734
Abstract: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ 95% CI [–124.7, –23.4] P=.006) and saturated fat (–0.4 g 95% CI [–0.7, –0.1] P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2 95% CI [1.1, 1.4] P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9] P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally however, more research is required. Australian New Zealand Clinical Trials Registry ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075
Publisher: JMIR Publications Inc.
Date: 29-03-2021
DOI: 10.2196/29094
Publisher: Wiley
Date: 17-01-2010
Publisher: JMIR Publications Inc.
Date: 26-05-2022
DOI: 10.2196/35771
Abstract: Few translational trials have provided detailed reports of process evaluation results. This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P .05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention however, more participants actively withdrew from the telephone intervention. This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: BMJ
Date: 11-09-2015
Publisher: Springer Science and Business Media LLC
Date: 08-10-2010
Publisher: F1000 Research Ltd
Date: 03-03-2022
DOI: 10.12688/HRBOPENRES.13507.1
Abstract: Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two or more members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies.
Publisher: Elsevier BV
Date: 09-2014
DOI: 10.1016/J.ORCP.2013.10.004
Abstract: Pediatric obesity continues to be a major public health concern. Once established it is difficult to treat, therefore well-designed and evaluated prevention interventions are vitally important. Schools have an important role in the prevention of childhood obesity, however, their involvement can be limited by a number of constraints and barriers, which need to be considered when designing interventions. Members of the Prevention Stream of the Australasian Child and Adolescent Obesity Research Network have extensive experience in implementing and evaluating school-based obesity prevention initiatives. Based on their collective experience and evidence from implementation research, the aim of this paper was to highlight six areas to consider when designing, implementing and evaluating obesity prevention initiatives in schools. Further, this paper aimed to provide guidance for overcoming some of the challenges and barriers faced in school-based obesity prevention research. The six key areas discussed include: design and analysis school-community engagement planning and recruitment evaluation implementation and feedback and sustainability.
Publisher: F1000 Research Ltd
Date: 20-09-2022
DOI: 10.12688/HRBOPENRES.13507.2
Abstract: Background: Tailoring strategies to target the salient barriers to and enablers of implementation is considered a critical step in supporting successful delivery of evidence based interventions in healthcare. Theory, evidence, and stakeholder engagement are considered key ingredients in the process however, these ingredients can be combined in different ways. There is no consensus on the definition of tailoring or single method for tailoring strategies to optimize impact, ensure transparency, and facilitate replication. Aim: The purpose of this scoping review is to describe how tailoring has been undertaken within healthcare to answer questions about how it has been conceptualised, described, and conducted in practice, and to identify research gaps. Methods: The review will be conducted in accordance with best practice guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Searches will be conducted of MEDLINE, Embase, Web of Science, Scopus, from 2005 to present. Reference lists of included articles will be searched. Grey literature will be searched on Google Scholar. Screening and data extraction will be conducted by two or more members of the research team, with any discrepancies resolved by consensus discussion with a third reviewer. Initial analysis will be quantitative involving a descriptive numerical summary of the characteristics of the studies and the tailoring process. Qualitative content analysis aligned to the research questions will also be conducted, and data managed using NVivo where applicable. This scoping review is pre-registered with the Open Science Framework. Conclusions: The findings will serve a resource for implementation researchers and practitioners to guide future research in this field and facilitate systematic, transparent, and replicable development of tailored implementation strategies.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2021
DOI: 10.1186/S12966-021-01206-8
Abstract: 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. 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. 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). 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. Australian New Zealand Clinical Trials Registry ACTRN12617000681358 prospectively registered 12th May 2017.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2010
Publisher: Springer Science and Business Media LLC
Date: 12-2011
Publisher: Springer Science and Business Media LLC
Date: 15-10-2015
Publisher: Elsevier BV
Date: 06-2008
DOI: 10.1016/J.JCLINEPI.2007.10.005
Abstract: To assess how information about adverse events is included in systematic reviews. We included all new Cochrane reviews published in the Cochrane Database of Systematic Reviews (CDSRs) and all new reviews (2003--2004) in the Database of Abstracts of Reviews of Effects (DAREs) in Issue 1 2005 of The Cochrane Library. More than half of Cochrane (44/78) and DARE (46/79) reviews assessed drug interventions. The rest assessed surgery (Cochrane [12] DARE [10]), psychosocial, educational, or physiotherapy interventions (22 23). Seventy-six percent (59/78) of Cochrane reviews mentioned adverse events as an outcome compared with 48% (38/79) of DARE reviews. Most reviews mentioning adverse events were of drug interventions (Cochrane [41/59] DARE reviews [29/38]). Considering reviews that mentioned adverse events, 95% (56/59) of Cochrane reviews included only randomized trials and 73% (43/59) included an analysis of adverse events. For 10 Cochrane reviews, adverse events had not been reported by the included trials. In contrast, 58% (22/38) of DARE reviews mentioning adverse events included only randomized trials, the rest included both randomized and nonrandomized studies. Most Cochrane reviews of drug interventions considered adverse events. This was not the case for DARE reviews and for Cochrane reviews of nondrug interventions. This could be improved.
Publisher: JMIR Publications Inc.
Date: 30-11-2020
Abstract: chool 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. his 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. he 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 i everyday /i , i occasional /i , and i caution /i (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. rom baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1 i P /i =.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4 i P /i & .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% i P /i & .001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9% i P /i =.02). Relative to control schools, intervention schools had significantly greater odds of having i everyday /i items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0 i P /i & .001), corresponding to a 9.8% increase in i everyday /i items, and lower odds of having i occasional /i items purchased (OR 0.7, 95% CI 0.6-0.8 i P /i & .001), corresponding to a 7.7% decrease in i occasional /i items) however, there was no change in the odds of having i caution /i (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0 i P /i =.05). Furthermore, there was no change in schools’ revenue between groups. iven 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. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. R2-10.1136/bmjopen-2019-030538
Publisher: Elsevier BV
Date: 02-2014
DOI: 10.1016/J.APPET.2013.10.013
Abstract: Labelling of food from fast food restaurants at point-of-purchase has been suggested as one strategy to reduce population energy consumption and contribute to reductions in obesity prevalence. The aim of this study was to examine the effects of energy and single traffic light labelling systems on the energy content of child and adult intended food purchases. The study employed a randomised controlled trial design. English speaking parents of children aged between three and 12 years were recruited from an existing research cohort. Participants were mailed one of three hypothetical fast food menus. Menus differed in their labelling technique – either energy labels, single traffic light labels, or a no-label control. Participants then completed a telephone survey which assessed intended food purchases for both adult and child. The primary trial outcome was total energy of intended food purchase. A total of 329 participants completed the follow-up telephone interview. Eighty-two percent of the energy labelling group and 96% of the single traffic light labelling group reported noticing labelling information on their menu. There were no significant differences in total energy of intended purchases of parents, or intended purchases made by parents for children, between the menu labelling groups, or between menu labelling groups by socio-demographic subgroups. This study provided no evidence to suggest that energy labelling or single traffic light labelling alone were effective in reducing the energy of fast food items selected from hypothetical fast food menus for purchase. Additional complementary public health initiatives promoting the consumption of healthier foods identified by labelling, and which target other key drivers of menu item selection in this setting may be required.
Publisher: Springer Science and Business Media LLC
Date: 21-01-2016
Publisher: BMJ
Date: 09-2016
Publisher: Springer Science and Business Media LLC
Date: 03-09-2020
DOI: 10.1186/S12966-020-01008-4
Abstract: Prolonged sitting time is a risk factor for chronic disease, yet recent global surveillance is not well described. The aims were to clarify: (i) the countries that have collected country-level data on self-reported sitting time (ii) the single-item tools used to collect these data and (iii) the duration of sitting time reported across low- to high-income countries. Country-level data collected within the last 10 years using single-item self-report were included. The six-stage methodology: (1) reviewing Global Observatory for Physical Activity! Country Cards (2–4) country-specific searches of PubMed, the Demographic and Health Survey website and Google (5) analysing the Eurobarometer 88.4 and (6) country-specific searches for World Health Organization STEPwise reports. A total of 7641 records were identified and screened for eligibility. Sixty-two countries (29%) reported sitting time representing 47% of the global adult population. The majority of data were from high-income (61%) and middle income (29%) countries. The tools used were the International Physical Activity Questionnaire (IPAQ n = 34), a modified IPAQ ( n = 1) or the Global Physical Activity Questionnaire (GPAQ n = 27). The median of mean daily sitting times was 4.7 (IQR: 3.5–5.1) hours across all countries. Higher-income countries recorded a longer duration of sitting time than lower-income countries (4.9 vs 2.7 h). This study provides an updated collation of countries collecting self-reported sitting time data. The daily sitting time findings should be interpreted cautiously. Current surveillance of sitting time is limited by a lack of coverage. Measures of population sitting time that are valid, feasible and sensitive to change should be embedded within global surveillance systems, to help guide future policy, research and practice. Not applicable.
Publisher: BMJ
Date: 04-2014
Publisher: Wiley
Date: 04-10-2016
Publisher: Springer Science and Business Media LLC
Date: 18-07-2014
Publisher: Wiley
Date: 20-11-2018
DOI: 10.1002/HPJA.218
Abstract: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39 95% CI 0.16-0.95, P = 0.038). This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. SO WHAT?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.
Publisher: Oxford University Press (OUP)
Date: 10-09-2014
Abstract: This study was aimed to assess, using vignettes, the impact of a hypothetical 'designated driver' (DD) initiative on level of intended alcohol consumption. A secondary aim was to assess whether using any form of transport where someone else drove was associated with level of intended consumption. A total of 390 in idual sports club members from 72 clubs in New South Wales, Australia, completed a telephone survey. In iduals were randomized into one of two groups: one receiving a hypothetical vignette where the sports club members drank in a setting that provided a DD program and the other receiving a vignette where the setting in which sports club members drank did not have a DD program. In iduals in both groups were asked to estimate the amount of alcohol they would be likely to consume and the time over which they would consume alcohol, and to indicate the likely means of traveling home afterwards. No difference in the amount of alcohol intended to be consumed between those in the DD and the non-DD group was identified. However, secondary analysis identified that, after controlling for group allocation, greater alcohol consumption was reported by in iduals who used transport that relied on someone else to drive them home. DD programs implemented in community sports clubs may not affect intended alcohol consumption by club members. However, using someone else to drive home was associated with greater alcohol consumption. To mitigate against this risk, licensed premises that implement safe transport strategies should consider the use of additional strategies to moderate alcohol consumption that may be inadvertently encouraged. (Australian Clinical Trials Registry) ACTRN12611000831987.
Publisher: Wiley
Date: 13-02-2022
DOI: 10.1002/HPJA.579
Publisher: Springer Science and Business Media LLC
Date: 15-04-2014
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.DRUGALCDEP.2014.08.014
Abstract: Few studies have examined the prevalence of unhealthy alcohol use in the hospital outpatient setting. Our aim was to estimate the prevalence of unhealthy alcohol use among patients attending a broad range of outpatient clinics at a large public hospital in Australia. Adult hospital outpatients were invited to complete the Alcohol Use Disorders Identification Test Consumption questions (AUDIT-C) using an iPad as part of a randomised trial testing the efficacy of alcohol electronic screening and brief intervention. Unhealthy alcohol use was defined as an AUDIT-C score ≥5 among men and ≥4 among women. Sixty percent (3616/6070) of invited hospital outpatients consented, of whom 89% (3206/3616) provided information on their alcohol consumption (either reported they had not consumed any alcohol in the last 12 months or completed the AUDIT-C). The prevalence of unhealthy alcohol use was 34.7% (95% confidence interval [CI]: 33.0-36.3%). The prevalence among men aged 18-24 years, 25-39 years, 40-59 years and 60 years and older, was 74.4% (95% CI: 68.4-80.4%), 54.3% (95% CI: 48.7-59.8%), 44.1% (95% CI: 39.9-48.3%), and 27.0% (95% CI: 23.6-30.4%), respectively (43.1% overall 95% CI: 40.8-45.5%). The prevalence among women aged 18-24 years, 25-39 years, 40-59 years, and 60 years and older, was 48.6% (95% CI: 39.2-58.1%), 36.9% (95% CI: 31.2-42.6%), 25.2% (95% CI: 21.5-29.0%) and 14.5% (95% CI: 11.7-17.3%), respectively (24.9% overall 95% CI: 22.7-27.1%). A large number of hospital outpatients who are not currently seeking treatment for their drinking could benefit from effective intervention in this setting.
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-021047
Abstract: Interventions addressing the in idual and environmental protective factors of adolescents are suggested to have potential for reducing adolescent substance use. While universally delivered school-based substance use prevention interventions are common, previous studies have suggested variable effectiveness by subgroups of students. An exploratory study was undertaken to examine the differential effectiveness of a universal school-based resilience intervention on adolescent substance use and protective factors according to their sociodemographic and previous substance use. Secondary analysis of data from a cluster-randomised controlled trial. 32 Australian secondary schools. Cohort of grade 7 students (n=3155) followed up in grade 10 (aged 15–16 years 2014 n=2105). Three-year universal school-based intervention implemented by school staff that targeted a range of student resilience protective factors (2012–2014). Primary outcomes included: tobacco (recent, number of cigarettes) and alcohol (recent, ‘risk’ and number of drinks) use, and secondary outcomes included: marijuana (recent) and other illicit substance (recent) use, and aggregate in idual and environmental protective factor scores. Generalised and linear mixed models examined interactions between treatment and student subgroups (gender socioeconomic disadvantage (low/high) geographic location (major city/inner regional/outer regional-remote) and previous substance use (non-user/user)) at follow-up (36 models). Analysis of student follow-up data showed no differential intervention effect for any substance use or protective factor outcome for any subgroup, with the exception of one differential effect found by socioeconomic status for the outcome of mean number of cigarettes smoked by recent smokers (p=0.003). There was no evidence of an intervention effect within the low (mean difference (MD) −12.89, 95% CI −26.00 to 0.23) or high (MD 16.36, 95% CI −1.03 to 33.76) socioeconomic subgroups. No evidence of an intervention effect on substance use and protective factors was found according to student subgroups defined by sociodemographic characteristics or previous substance use. ACTRN12611000606987.
Publisher: Wiley
Date: 26-11-2018
DOI: 10.1002/HPJA.214
Abstract: To: (i) describe the prevalence of policies and practices promoting healthy eating implemented by sports clubs with junior teams (ii) examine differences in such practices across geographic and operational characteristics of clubs and (iii) describe the attitudes of club representatives and parents regarding the acceptability of sports clubs implementing policies and practices to promote healthy eating. Cross-sectional telephone surveys of junior community football club management representatives and parents/carers of junior players were conducted in the states of New South Wales and Victoria, Australia in 2016. Seventy-nine of the 89 club representatives approached to participate completed the telephone survey. All clubs (100% 95% CI 96.2-100.0) reported recommending fruit or water be provided to players after games or at half-time, 24% (95% CI 14.4-33.7) reported promoting healthy food options through prominent positioning at point of sale and only 8% (95% CI 1.6-13.6) of clubs had a written healthy eating policy. There were no significant differences between the mean number of healthy eating policies and practices implemented by club socio-economic or geographic characteristics. Club representatives and parents/carers were supportive of clubs promoting healthy eating for junior players. While there is strong support within sporting clubs with junior teams for policies and practices to promote healthy eating, their implementation is highly variable. SO WHAT?: A considerable opportunity remains for health promotion policy and practice improvement in clubs with junior teams, particularly regarding policies related to nutrition.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2014
Publisher: JMIR Publications Inc.
Date: 04-02-2020
DOI: 10.2196/13401
Abstract: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups (2) in idual food groups and (3) mean servings of in idual food groups. Childcare service use and acceptability of the Web-based program were also assessed. A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for in idual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P .001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. Although improvements in childcare service overall menu and in idual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404 www.anzctr.org.au/ACTRN12616000974404.aspx
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: Elsevier BV
Date: 08-2015
Publisher: Elsevier BV
Date: 08-2016
DOI: 10.1016/J.AMEPRE.2016.02.020
Abstract: Few interventions have been successful in reducing the physical activity decline typically observed among adolescents. The aim of this paper is to report the 24-month effectiveness of a multicomponent school-based intervention (Physical Activity 4 Everyone) in reducing the decline in moderate to vigorous physical activity (MVPA) among secondary school students in disadvantaged areas of New South Wales, Australia. A cluster RCT was conducted in five intervention and five control schools with follow-up measures taken at 24 months post-randomization. The trial was undertaken within secondary schools located in disadvantaged communities in New South Wales, Australia. A multicomponent school-based intervention based on the Health Promoting Schools Framework was implemented. The intervention consisted of seven physical activity promotion strategies that targeted the curriculum (teaching strategies to increase physical activity in physical education lessons, student physical activity plans, and modification of school sport program) school environment (recess/lunchtime activities, school physical activity policy) parents (parent newsletters) and community (community physical activity provider promotion). Six additional strategies supported school implementation of the physical activity intervention strategies. Minutes per day spent in MVPA, objectively measured by accelerometer. Participants (N=1,150, 49% male) were a cohort of students aged 12 years (Grade 7) at baseline (March-June 2012) and 14 years (Grade 9) at follow-up (March-July 2014). At 24-month follow-up, there were significant effects in favor of the intervention group for daily minutes of MVPA. The adjusted mean difference in change in daily MVPA between groups was 7.0 minutes (95% CI=2.7, 11.4, p<0.002) (analysis conducted December 2014-February 2015). Sensitivity analyses based on multiple imputation were consistent with the main analysis (6.0 minutes, 95% CI=0.6, 11.3, p<0.031). The intervention was effective in increasing adolescents' minutes of MVPA, suggesting that implementation of the intervention by disadvantaged schools has the potential to slow the decline in physical activity. Australian New Zealand Clinical Trials Registry ACTRN12612000382875.
Publisher: Elsevier BV
Date: 08-2015
DOI: 10.1016/J.AMEPRE.2015.02.002
Abstract: Schools represent a valuable setting for interventions to improve children's diets, as they offer structured opportunities for ongoing intervention. Modifications to the school food environment can increase purchasing of healthier foods and improve children's diets. This study examines the availability of healthy food and drinks, implementation of pricing and promotion strategies in Australian primary school canteens, and whether these varied by school characteristics. In 2012 and 2013, canteen managers of primary schools in the Hunter New England region of New South Wales reported via telephone interview the pricing and promotion strategies implemented in their canteens to encourage healthier food and drink purchases. A standardized audit of canteen menus was performed to assess the availability of healthy options. Data were analyzed in 2014. Overall, 203 (79%) canteen managers completed the telephone interview and 170 provided menus. Twenty-nine percent of schools had menus that primarily consisted of healthier food and drinks, and 11% did not sell unhealthy foods. Less than half reported including only healthy foods in meal deals (25%), labeling menus (43%), and having a comprehensive canteen policy (22%). A significantly larger proportion of schools in high socioeconomic areas (OR=3.0) and large schools (OR=4.4) had primarily healthy options on their menus. School size and being a Government school were significantly associated with implementation of some pricing and promotion strategies. There is a need to monitor canteen environments to inform policy development and research. Future implementation research to improve the food environments of disadvantaged schools in particular is warranted.
Publisher: Wiley
Date: 05-03-2021
DOI: 10.1002/HPJA.469
Abstract: 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. 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. 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). 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. 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.
Publisher: Springer Science and Business Media LLC
Date: 08-08-2020
DOI: 10.1186/S12966-020-01000-Y
Abstract: ‘Physical Activity 4 Everyone’ (PA4E1) was an efficacious multi-component school-based physical activity (PA) program targeting adolescents. PA4E1 has seven PA practices. It is essential to scale-up, evaluate effectiveness and assess implementation of such programs. Therefore, the aim is to assess the impact of implementation support on school practice uptake of the PA4E1 program at 12 and 24 months. A cluster randomised controlled trial, utilising a type III hybrid implementation-effectiveness design, was conducted in 49 randomly selected disadvantaged Australian Government and Catholic secondary schools. A blinded statistician randomly allocated schools to a usual practice control ( n = 25) or the PA4E1 program group ( n = 24), with the latter receiving seven implementation support strategies to support school PA practice uptake of the seven practices retained from the efficacy trial. The primary outcome was the proportion of schools adopting at least four of the seven practices, assessed via telephone surveys with Head Physical Education Teachers and analysed using exact logistic regression modelling. This paper reports the 12-month outcomes. Schools were recruited from May to November 2017. At baseline, no schools implemented four of the seven practices. At 12 months significantly more schools in the program group had implemented four of the seven practices (16/24, 66.7%) than the control group (1/25, 4%) (OR = 33.0[4.15–1556.4], p 0.001). The program group implemented on average 3.2 (2.5–3.9) more practices than the control group ( p 0.001, mean 3.9 (SD 1.5) vs 0.7 (1.0)). Fidelity and reach of the implementation support intervention were high (both 80%). Through the application of multiple implementation support strategies, secondary schools were able to overcome commonly known barriers to implement evidence based school PA practices. As such practices have been shown to result in an increase in adolescent PA and improvements in weight status, policy makers and practitioners responsible for advocating PA in schools should consider this implementation approach more broadly when working with schools. Follow-up is required to determine whether practice implementation is sustained. Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12th May 2017.
Publisher: Wiley
Date: 12-2018
DOI: 10.1002/HPJA.220
Abstract: Online systems offer opportunities to provide effective, ongoing support to childcare services to implement dietary guidelines. The study aimed to assess the effectiveness of a dissemination strategy on childcare service: (i) adoption and (ii) use of an online menu planning program designed to increase compliance with dietary guidelines. A nonrandomised controlled trial was conducted with long day care services across Australia. All services received an email invitation to access an online evidence-based menu planning program. Services in the intervention also received training, telephone contact and provision of a portable computer tablet to encourage program adoption and use. Outcomes were assessed at the 6-month follow-up using analytics data recorded by the online program. Outcomes included the proportion of services having accessed the program (adoption) and the proportion of services with a current menu entered in the program (use as intended). Twenty-seven interventions and 19 control services took part. At the 6-month follow-up, 100% vs 58% of services had adopted the online menu planning program (OR: 14.67, 95% CI: 2.43-infinity P < 0.01) and 41% vs 5% of services had a current menu entered in the program (OR: 9.99, 95% CI: 1.01-534.57 P < 0.01) in the intervention and control arms respectively. This study highlights the need for strategies to support adoption and use of an online menu planning program in childcare services if the potential benefits of such a program are to be achieved. Future research should explore the effectiveness of differing strategies to increase adoption and use of online programs at scale. SO WHAT?: Strategies to support childcare service uptake and use of online programs are required in order for the potential public health benefits of such technologies to be realised.
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Cambridge University Press (CUP)
Date: 09-01-2014
DOI: 10.1017/S1368980013003364
Abstract: To determine the impact of an implementation intervention designed to introduce policies and practices supportive of healthy eating in centre-based child-care services. Intervention strategies included staff training, resources, incentives, follow-up support, and performance monitoring and feedback. A quasi-experimental design was used to assess change over 20 months in healthy eating policy and practice in intervention and comparison child-care services. The Hunter New England (HNE) region of New South Wales (NSW), Australia. All centre-based child-care services ( n 287) in the intervention region (HNE) were invited and 240 (91 % response rate) participated. Two hundred and ninety-six services in the rest of NSW were randomly selected as a comparison region and 191 participated (76 % response rate). A sub-analysis was conducted on those services that provided children food ( n 196 at baseline and n 190 at follow-up). Ninety-six provided menus for analysis at baseline (HNE, n 36 NSW, n 50) and 102 provided menus at follow-up (HNE, n 50 NSW, n 52). Services in the intervention region were significantly more likely to provide only plain milk and water for children ( P = 0·018) and to engage parents in nutrition policy or programmes ( P = 0·002). They were also more likely ( P = 0·056) to have nutrition policy on home packed food. In addition, menus of services that provided lunch were significantly more likely to comply with healthy eating guidelines for sweetened drinks ( P 0·001), fruit ( P 0·001) and vegetables ( P = 0·01). An implementation intervention was able to modify policy and practice in a large number of child-care services so that they were more supportive of healthy eating.
Publisher: Springer Science and Business Media LLC
Date: 07-2020
DOI: 10.1186/S13012-020-01011-0
Abstract: Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an in idual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews. As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, in idual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework. The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects. Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76). This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change. This review was not prospectively registered.
Publisher: Springer Science and Business Media LLC
Date: 12-2015
Publisher: JMIR Publications Inc.
Date: 06-07-2020
Abstract: ew Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. his study aimed to assess in a national s le of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly s led from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived in idual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. indings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The i changes needed in team interactions /i subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with i organization’s capacity to innovate /i scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of i ease of the adoption decision /i ( i P /i & .001) and i identifying work and in iduals involved in implementation /i ( i P /i =.001) were significantly associated with high intentions to adopt digital health interventions. substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.BIOS.2009.07.021
Abstract: Direct measurement of the biomechanical stress induced by a live cell during endocytosis is reported. Fluorescent dye-doped polystyrene microspheres were used as microscopic remote optical sensors applying whispering gallery modes (WGMs) as transducer mechanism. Monitoring of the WGMs throughout the incorporation of the microsphere into the cell enabled the determination of the deformation experienced by the microsphere, characterized by both a broadening and a blue shift of the resonances, and consequently the stress induced by the cell. The results reveal an unexpectedly high stress with a magnitude of up to five times that of the passive cortical tension, which can be only explained by a so far undetermined active stress component induced by the cytoskeletal machinery during particle incorporation. The method is adaptable to the study of any other kind of phagocyte and thus provides a novel research tool of high interest for cell biology.
Publisher: Springer Science and Business Media LLC
Date: 07-11-2012
Publisher: Wiley
Date: 06-04-2016
DOI: 10.1002/PON.4129
Publisher: BMJ
Date: 05-2014
Publisher: Springer Science and Business Media LLC
Date: 22-08-2016
Publisher: Wiley
Date: 09-2015
DOI: 10.1111/DAR.12330
Abstract: Enforcement of liquor licensing laws is limited by inadequate police information systems. This study aimed to: (i) determine the effectiveness of an intervention in facilitating police recording of the alcohol consumption characteristics of people involved in assaults and (ii) describe such characteristics by geographic area and setting of alcohol consumption. A stepped wedge trial was conducted across New South Wales, Australia. An intervention to facilitate police recording of alcohol consumption information for people involved in incidents was implemented. For people involved in an assault the proportion for which alcohol consumption information was recorded was assessed. The proportion of assaults that were alcohol related, the proportions of people that consumed alcohol prior to the assault, were intoxicated, and had consumed alcohol in various settings, are described. Post-intervention, alcohol consumption information was recorded for 85-100% of people involved in an assault incident. The proportion of incidents recorded as alcohol-related increased significantly (26-44.5% P < 0.0001). The proportion of assaults classified as alcohol related was significantly greater in regional/rural areas (50-47%) than in metropolitan areas (38%). More people in metropolitan areas (54%) consumed alcohol on licensed premises prior to an assault than in regional/rural areas (39-42%), with approximately 70% of persons intoxicated regardless of setting of alcohol consumption. Twenty per cent of premises accounted for 60% of assaults linked to licensed premises. The intervention was effective in enhancing the recording of alcohol-related information for assault incidents. Such information could enhance targeted policing of liquor licensing laws. [Wiggers JH, Hacker A, Kingsland M, Lecathelinais C, Tindall J, Bowman JA, Wolfenden L. Facilitating police recording of the alcohol-related characteristics of assault incidents: A stepped wedge implementation trial. Drug Alcohol Rev 2015 :000-000].
Publisher: Wiley
Date: 13-03-2019
DOI: 10.1111/OBR.12845
Abstract: Maximizing the benefits of investments in obesity research requires effective interventions to be adopted and disseminated broadly across populations (scaled-up). However, interventions often need considerable adaptation to enable implementation at scale, a process that can reduce the effects of interventions. A systematic review was undertaken for trials that sought to deliver an obesity intervention to populations on a larger scale than a preceding randomized controlled trial (RCT) that established its efficacy. Ten scaled-up obesity interventions (six prevention and four treatment) were included. All trials made adaptations to interventions as part of the scale-up process, with mode of delivery adaptations being most common. A meta-analysis of body mass index (BMI)/BMI z score (zBMI) from three prevention RCTs found no significant benefit of scaled-up interventions relative to control (standardized mean difference [SMD] = 0.03 95% CI, -0.09 to 0.15, P = 0.639 - I
Publisher: Wiley
Date: 29-10-2014
DOI: 10.1111/DAR.12210
Abstract: Across the world, it has been estimated that approximately 270 million people participate in community football clubs. However, the community sports club setting is associated with high levels of risky alcohol consumption. The study examined if sporting club alcohol management practices are associated with risky consumption of alcohol by club members while at the club, and also whether such consumption is directly and indirectly associated with club member overall hazardous alcohol consumption. Telephone surveys were conducted with a representative from 72 community football clubs in New South Wales, Australia, and 1428 club members. A path and mediation analysis was undertaken to determine the association between 11 club alcohol management practices and member alcohol consumption, at the club and overall hazardous consumption. Three alcohol management practices were associated with an increased probability of risky drinking while at the club: having alcohol promotions serving intoxicated patrons and having bar open longer than 4 h. A mediation analyses identified that risky drinking at the club as a result of these three practices was also linked to increase risk in being an overall hazardous drinker. Modifying alcohol management practices in community football clubs has the potential to reduce both risky alcohol consumption by members in this setting and the prevalence of overall hazardous alcohol consumption. Coordinated, multi-strategic interventions are required to support community football clubs to modify their alcohol management practices and hence contribute to reducing the burden of alcohol-related harm in the community.
Publisher: JMIR Publications Inc.
Date: 24-06-2021
DOI: 10.2196/25256
Abstract: 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. 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. 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. 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. 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. Australian Clinical Trials Registry ACTRN12618001731280 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191& isReview=true RR2-10.1186/s12889-019-7725-x
Publisher: Springer Science and Business Media LLC
Date: 05-07-2014
Publisher: Elsevier BV
Date: 02-2015
Publisher: Wiley
Date: 2009
DOI: 10.1111/J.1465-3362.2008.00003.X
Abstract: The provision of smoking cessation care to surgical patients before admission can reduce post-operative complications and encourage long-term smoking cessation. Our aim was to show how a comprehensive computer-based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision. Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer-based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. The computer-based intervention was found to provide a means to accurately and systematically identify smokers it required little clinical staff time or skill it was considered an acceptable form of care by staff and patients it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer-based intervention continues to operate in the preoperative clinic in the absence of ongoing research support. The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.
Publisher: Springer Science and Business Media LLC
Date: 22-01-2013
Publisher: Wiley
Date: 02-08-2016
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: BMJ
Date: 10-09-2015
Publisher: Wiley
Date: 24-08-2019
DOI: 10.1002/HPJA.285
Abstract: Modifying the scheduling of physical activity opportunities to provide children with more frequent opportunities for outdoor free play has been demonstrated to increase child physical activity while in care. The primary aim of this study was to describe the implementation of continuous free play schedules to allow children to access outdoor play areas, consistent with sector guidelines in a national s le of Australian childcare services. Secondary aims were to investigate the associations between the implementation of such schedules and service characteristics, and assess the perceived barriers and enablers to implementation. A cross-sectional study was undertaken with a random s le of 326 centre-based childcare services located across Australia. Childcare service characteristics, continuous free play scheduling and perceived barriers and enablers to implementation were assessed via a survey administered to service managers online or via telephone. A total of 203 service managers (62%) reported implementing a continuous free play schedule, for three periods of 126 minutes per period, each day on average. Service type (long day care services), size (services with higher numbers of child enrolments [≥80 children]) and socio-economic area (services located in lower socio-economic areas) were associated with the implementation of a continuous free play schedule. The most prevalent barriers to implementation included insufficient staff to ensure adequate supervision of children (69%) and service layout being unsuitable (65%), while the most prevalent enablers included advice on how to overcome staffing or supervision issues (89%) and to re-orientate the service layout (54%). There is scope to support the implementation of continuous free play schedules consistent with childcare sector guidelines. SO WHAT?: Future intervention research that targets the reported barriers and enablers to implementation is needed.
Publisher: BMJ
Date: 30-09-2011
Publisher: Oxford University Press (OUP)
Date: 12-2008
Publisher: Wiley
Date: 06-05-2016
Publisher: BMJ
Date: 04-2017
Publisher: Elsevier BV
Date: 02-2012
Publisher: BMJ
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 17-03-2020
DOI: 10.1186/S13063-020-4187-5
Abstract: Physical Activity 4 Everyone (PA4E1) is a physical activity program for secondary schools located in low-socioeconomic areas. Over a 24-month period, schools in the program arm of a cluster randomised controlled trial (n = up to 38 schools) will receive a multi-component implementation support strategy to embed the seven school physical activity practices of the PA4E1 program. This article describes the process evaluation of the PA4E1 hybrid implementation-effectiveness trial. The process evaluation aims to describe the fidelity and reach of the implementation support strategies using quantitative data and to describe the acceptability, appropriateness and feasibility of the implementation support strategies and physical activity practices to school stakeholders using mixed methods. Quantitative and qualitative data will be collected from participants (Physical Education teachers, in-School Ch ions, students) in the program arm. Data collection will involve semi-structured interviews, focus groups, a fidelity monitoring log, a fidelity checklist, surveys, and routinely collected administrative and website data. Quantitative data will be analysed descriptively and qualitative data will be analysed thematically within and across data sets. Triangulation between data sources will be used to synthesise findings regarding the implementation and potential mechanisms of impact of PA4E1 on school physical activity practice adoption, with respect to context. Results of the process evaluation will facilitate the interpretation of the findings of the trial outcomes. It will comprehensively describe what was actually implemented and identify the potential contribution of the various components of the implementation support strategy to the school physical activity practice adoption outcomes. Findings will inform future improvement and scale-up of PA4E1 and approaches to implementing secondary school-based physical activity programs more broadly. Australian New Zealand Clinical Trials Registry ACTRN12617000681358 registered 12 May 2017.
Publisher: JMIR Publications Inc.
Date: 17-01-2022
Abstract: arents are the primary decision makers of the foods prepared and offered to children. There is a strong association between parent and child fruit and vegetable intakes. Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents, however there is currently limited evidence demonstrating this effect when the intervention is offered to the community remotely (using digital technologies i.e. telephone or online) as part of existing preventive health services. o assess the effectiveness of two digital interventions (computer-assisted telephone or online) healthy eating and active living interventions delivered at scale to parents of children aged 2-6 years, for increasing parent fruit and vegetable consumption (secondary outcome) at 9-months post baseline. arents (n=458) were recruited to a partially randomized preference trial comprising of three arms: 1. Computer-assisted telephone intervention 2. Online intervention 3. Written material (Control). This design allowed parents with a strong preference to select their preferred intervention and once preference trends were established, parents were randomized to obtain robust relative effects. Data were analyzed for randomized participants, preference participants and all participants. t 9-months post-baseline, parents randomized to the computer-assisted telephone intervention (n=73) had significantly higher vegetable consumption compared with parents randomized to the control (n=81) (+0.41 serves/day (95% CI: 0.02 to 0.81), p=0.04). However, there were no differences in vegetable consumption between parents who chose the computer-assisted telephone intervention (n=22) compared to those who chose the control (n=64) (preference participants). No differences in parent fruit consumption were found for randomized or preference participants for either the computer-assisted telephone or online intervention. Similarly, analysis of all participants combined found no differences in parent consumption of fruit or vegetables between either the computer-assisted telephone (n=95) or online (n=218) intervention group compared with the control (n=145). here may be some benefit to parents participating in computer-assisted telephone interventions aimed at improving the eating behaviors of their children. Future research is recommended to explore methods for optimizing parent engagement with technology-based interventions, to enable greater health benefits for both parents and their children. TN: U1111-1228-9748, ACTRN: 12619000396123
Publisher: JMIR Publications Inc.
Date: 25-03-2021
Abstract: EMOVE
Publisher: Oxford University Press (OUP)
Date: 13-05-2011
DOI: 10.1093/HER/CYR033
Abstract: School-based vegetable and fruit programs can increase student consumption of vegetables and fruit and have been recommended for adoption by Australian schools since 2005. An understanding of the prevalence and predictors of and the barriers to the adoption of school-based vegetable and fruit programs is necessary to maximize their adoption by schools and ensure that the health benefits of such programs to children are realized. The aim of this study was to determine Australian primary school Principals' attitudes and barriers to the implementation of vegetable and fruit breaks the prevalence of vegetable and fruit breaks in schools and the implementation strategies used and associated with their recommended adoption (daily in at least 80% of classes). A random s le of 384 school Principals completed a 20-min telephone interview. While Principals were highly supportive of vegetable and fruit breaks, only 44% were implementing these to a recommended level. When controlling for all school characteristics, recommended vegetable and fruit break adoption was 1.9 and 2.2 times greater, respectively, in schools that had parent communication strategies and teachers trained. A substantial opportunity exists to enhance the health of children through the adoption of vegetable and fruit breaks in schools.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2013
Publisher: JMIR Publications Inc.
Date: 26-07-2021
DOI: 10.2196/26690
Abstract: 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. The 2 objectives were to (1) describe the usage of the PA4E1 program website by in-school ch ions (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 ch ions using mixed 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 ch ions (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. For the first objective, in-school ch ions 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. 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. Australian New Zealand Clinical Trials Registry ACTRN12617000681358 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372870
Publisher: JMIR Publications Inc.
Date: 19-02-2021
DOI: 10.2196/23180
Abstract: 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. 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). 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 s led or recruited in iduals on the basis of pre-existing health-related conditions were excluded. In addition, studies were excluded if the in idual 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. 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). 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.
Publisher: Wiley
Date: 12-2013
DOI: 10.1071/HE13055
Publisher: BMJ
Date: 08-2018
DOI: 10.1136/BMJOPEN-2017-020042
Abstract: To evaluate the potential effectiveness of a practice change intervention in increasing preventive care provision in community-based substance use treatment services. In addition, client and clinician acceptability of care were examined. A pre-post trial conducted from May 2012 to May 2014. Public community-based substance use treatment services (n=15) in one health district in New South Wales (NSW), Australia. Surveys were completed by 226 clients and 54 clinicians at baseline and 189 clients and 46 clinicians at follow-up. A 12-month multistrategic clinician practice change intervention that aimed to increase the provision of preventive care for smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Client and clinician reported provision of assessment, brief advice and referral for three modifiable health risk behaviours: smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity. Clinician-reported optimal care was defined as providing care to 80% of clients or more. Client acceptability and clinician attitudes towards preventive care were assessed at follow-up. Increases in client reported care were observed for insufficient fruit and/or vegetable consumption including: assessment (24% vs 54%, p .001), brief advice (26% vs 46%, p .001), and clinicians speaking about (10% vs 31%, p .001) and arranging a referral (1% vs 8%, p=0.006) to telephone helplines. Clinician reported optimal care delivery increased for: assessment of insufficient fruit and/or vegetable consumption (22% vs 63%, p .001) and speaking about telephone helplines for each of the three health risk behaviours. Overall, clients and clinicians held favourable views regarding preventive care. This study reported increases in preventive care for insufficient fruit and/or vegetable consumption however, minimal increases were observed for smoking or insufficient physical activity. Further investigation of the barriers to preventive care delivery in community substance use settings is needed. ACTRN12614000469617.
Publisher: Wiley
Date: 21-06-2016
DOI: 10.1111/DAR.12439
Publisher: Springer Science and Business Media LLC
Date: 13-08-2012
Publisher: Springer Science and Business Media LLC
Date: 10-06-2016
DOI: 10.1038/IJO.2016.107
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.JADOHEALTH.2011.12.017
Abstract: The purpose of this study was to determine the prevalence, sociodemographic distribution, and co-occurrence of five potentially obesogenic behavioral risk factors (low physical activity, high screen time, low fruit and vegetable intake, high soft drink consumption, and high snack intake) among adolescents. Cross-sectional representative population survey (n = 1,568) of grade 6, 8, and 10 students (49% male) randomly selected from 70 primary and secondary schools in New South Wales, Australia, between February and May 2007. Co-occurrence was assessed using an observed-to-expected ratio (O/E) method. Only 5% of boys and 9% of girls had none of the five obesogenic behavioral risk factors studied. Overall, 51.4% of boys and 42.9% of girls had three or more risk factors. Prevalence of multiple risk factors (3+) was higher among boys and girls from lower income households and among girls whose mothers had less than grade 12 education. For both boys and girls, the occurrence of all five risk factors was 160% greater than expected (O/E ratio: 2.6). There was clear evidence of a co-occurrence of obesogenic risk factors among adolescents, especially among those from lower socioeconomic backgrounds, indicating this group would benefit from targeted prevention strategies.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JCLINEPI.2014.12.008
Abstract: To examine the research translation phase focus (T1-T4) of systematic reviews published in the Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). Briefly, T1 includes reviews of basic science experiments T2 includes reviews of human trials leading to guideline development T3 includes reviews examining how to move guidelines into policy and practice and T4 includes reviews describing the impact of changing health practices on population outcomes. A cross-sectional audit of randomly selected reviews from CDSR (n = 500) and DARE (n = 500) was undertaken. The research translation phase of reviews, overall and by communicable disease, noncommunicable disease, and injury subgroups, were coded by two researchers. A total of 898 reviews examined a communicable, noncommunicable, or injury-related condition. Of those, 98% of reviews within CDSR focused on T2, and the remaining 2% focused on T3. In DARE, 88% focused on T2, 8.7% focused on T1, 2.5% focused on T3, and 1.3% focused on T4. Almost all reviews examining communicable (CDSR 100%, DARE 93%), noncommunicable (CDSR 98%, DARE 87%), and injury (CDSR 95%, DARE 88%) were also T2 focused. Few reviews exist to guide practitioners and policy makers with implementing evidence-based treatments or programs.
Publisher: JMIR Publications Inc.
Date: 30-06-2017
DOI: 10.2196/RESPROT.6859
Publisher: BMJ
Date: 06-2016
Publisher: American Medical Association (AMA)
Date: 2015
DOI: 10.1001/JAMAOTO.2014.2700
Abstract: Burden of disease should inform research prioritization. To determine whether systematic reviews and protocols published in the Cochrane Database of Systematic Reviews (CDSR) appropriately reflect disease burden for otolaryngologic conditions as measured by the Global Burden of Disease (GBD) 2010 project. Two investigators independently assessed 10 otolaryngologic conditions in CDSR for systematic review and protocol representation from March to June 2014. The otolaryngologic diseases were matched to their respective GBD 2010 disability-adjusted life-years (DALYs) to assess their correlation. Relationship of CDSR representation (based on systematic reviews and protocols) with percentage of total 2010 DALYs, 2010 DALY rank, and DALY percentage change from 1990 to 2010 for 10 otolaryngologic conditions. All 10 otolaryngologic conditions were represented by at least 1 systematic review in CDSR. The number of reviews and protocols in CDSR was well matched with GBD 2010 disability metrics for only 1 disease, mouth cancer. Upper respiratory infections, otitis media, thyroid cancer, and cleft lip and cleft palate were overrepresented in CDSR, and esophageal cancer, "other hearing loss," nasopharynx cancer, larynx cancer, and "cancer of other part of pharynx and oropharynx" were underrepresented. The representation of otolaryngologic conditions in CDSR correlates poorly with DALY metrics. The results of this study may guide future research prioritization and allocation of funds.
Publisher: Wiley
Date: 20-05-2021
DOI: 10.1002/HPJA.499
Abstract: To determine if a school‐based physical activity (PA) intervention that supported primary school teachers to schedule PA during school hours impacted their own PA. A 2x2 factorial group cluster‐randomised controlled trial was undertaken in 12 Australian primary schools. The nine‐month intervention supported classroom teachers to increase scheduled weekly PA for their class via physical education, sport, Energisers and integrated lessons. Teachers’ PA (n = 76) was measured at follow‐up only using accelerometers (Actigraph GT3X or GT9X). Linear mixed models were used to estimate between‐group differences in teachers’ mean minutes of sedentary, light, moderate‐to‐vigorous‐intensity physical activity (MVPA) across the school day and during class‐time. At follow‐up, there were non‐significant between‐group differences favouring intervention teachers, compared to controls, for light PA (4.9 minutes, 95% CI: −6.3, 16.0 P = .33) and MVPA (0.4 minutes, 95% CI: −10.9, 11.6 P = .94) across the school day although not favouring the intervention for sedentary behaviour (5.1 minutes, 95% CI: −11.4, 21.7 P = .48). Similar patterns were seen during class‐time for light PA and sedentary time, but not for MVPA. Supporting teachers with the scheduling of PA for their class may impact on their own PA. Fully powered studies are needed to better understand the impact of the intervention on teachers’ PA. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001228471 ( www.anzctr.org.au/ ).
Publisher: Wiley
Date: 29-05-2020
DOI: 10.1002/HPJA.258
Abstract: The aim of this study was to assess potential barriers to the implementation of clinical guideline recommendations regarding maternal alcohol consumption by antenatal clinicians and managers. Cross-sectional surveys of antenatal clinicians and managers employed in a New South Wales Local Health District were undertaken. Survey items were developed based on 11 domains of the Theoretical Domains Framework. Consistent with previous studies, a cut point of less than 4 was applied to mean values of survey items (range: 1-5) to identify domains representing barriers to the implementation. Thirty-three antenatal clinicians and eight managers completed the surveys. For clinicians, the domains with the lowest mean values included "environmental context and resources" (ie, complexity of appointments and availability of supporting systems) (mean: 3.13, SD: 0.93) "social influences" (ie, expectations of others that alcohol will be addressed) (mean: 3.33, SD: 0.68) "beliefs about capabilities" (ie, confidence in providing guideline recommendations) (mean: 3.51, SD: 0.67) and "behavioural regulation" (ie, planning and responding to feedback) (mean: 3.53, SD: 0.64). For managers, "emotion regulation" (ie, stress in managing change) (mean: 2.13, SD: 0.64) and "environmental context and resources" (ie, complexities of managing change) (mean: 3.13, SD: 0.83) were the lowest scoring domains. The antenatal service environment and availability of resources appear to be primary barriers to both clinicians and managers implementing guidelines for maternal alcohol consumption. SO WHAT?: In the development of interventions to support the delivery of clinical guideline recommendations addressing alcohol consumption during pregnancy, a broad range of potential barriers at both the clinician and manager levels need to be considered and targeted by effective implementation strategies.
Publisher: American Medical Association (AMA)
Date: 02-2016
DOI: 10.1001/JAMAPEDIATRICS.2015.3342
Abstract: Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children. To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children. A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015. Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis. Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively. The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention. Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05 95% CI, 0.74-1.50 P = .78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53 95% CI, 1.10-2.14 P = .01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity. Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.
Publisher: Wiley
Date: 13-04-2016
DOI: 10.1071/HE15124
Publisher: Wiley
Date: 23-03-2016
DOI: 10.1111/OBR.12392
Abstract: The review describes the effectiveness of physical activity interventions implemented in centre-based childcare services and (i) examines characteristics of interventions that may influence intervention effects (ii) describes the effects of pragmatic interventions and non-pragmatic interventions (iii) assesses adverse effects and (iv) describes cost-effectiveness of interventions Data sources were Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, SCOPUS and SPORTDISCUS. Studies selected included randomized controlled trials conducted in centre-based childcare including an intervention to increase objectively measured physical activity in children aged less than 6 years. Data were converted into standardized mean difference (SMD) and analysed using a random effects model. Overall interventions significantly improved child physical activity (SMD 0.44 95% confidence interval [CI]: 0.12-0.76). Significant effects were found for interventions that included structured activity (SMD 0.53 95% CI: 0.12-0.94), delivery by experts (SMD 1.26 95% CI: 0.20-2.32) and used theory (SMD 0.76 95% CI: 0.08-1.44). Non-pragmatic (SMD 0.80 95% CI: 0.12-1.48) but not pragmatic interventions (SMD 0.10 95% CI:-0.13-0.33) improved child physical activity. One trial reported adverse events, and no trials reported cost data. Intervention effectiveness varied according to intervention and trial design characteristics. Pragmatic trials were not effective, and information on cost and adverse effects was lacking. Evidence gaps remain for policymakers and practitioners regarding the effectiveness and feasibility of childcare-based physical activity interventions.
Publisher: Springer Science and Business Media LLC
Date: 06-05-2019
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/JPC.12285
Abstract: The aim of this study was to determine if parent intentions to facilitate social interactions between their child and a peer, or parental perceptions of their child's peer social interaction intentions, differ according to the weight status of a child's peer. During a telephone survey, 250 Australian parents of children 5-12 years were randomly assigned to listen to one of two descriptions of a hypothetical child differing by group in the description of child weight status ('quite overweight' or 'healthy weight'). Parents then completed the Social Interaction Intention Scale, which assessed how likely they or their child would engage in a number of behaviours that may facilitate social interaction with the child described in the profile. Means scores on the overall scale and the child sub-scale of the Child Social Interaction Intention Scale were significantly higher among participants allocated to the healthy weight child profile, indicating more positive social intentions. The findings suggest that negative weight-based stereotypes hinder the development of peer friendships by obese children.
Publisher: Springer Science and Business Media LLC
Date: 2013
Publisher: Springer Science and Business Media LLC
Date: 09-06-2014
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.YPMED.2014.01.031
Abstract: Population-based, 'whole of community' interventions utilise community engagement processes and implement multiple strategies to improve the health of populations defined by geographical boundaries (i.e. cities, villages or regions). The aim of the review was to systematically assess the current state of knowledge about the effectiveness of population-based whole of community interventions in preventing excessive population weight gain. Systematic searches of electronic databases (1990-2011) and reference lists of included trials and previous reviews were conducted to identify interventions to prevent excessive weight gain. Population-based, whole of community interventions were defined as those targeting the weight status of a population characterised along geographical boundaries. The review included eight trials. All of the identified trials targeted children or adolescents. Seven trials reported a significant effect favouring the intervention on at least one measure of adiposity. Meta-analysis of six trials revealed a small reduction in BMI z-score among participants in intervention communities (mean difference (MD) -0.09 95% confidence interval (CI) -0.16 to -0.02). The review suggests that population-based, whole of community interventions can be effective in achieving modest reductions in population weight gain among children.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.AMEPRE.2014.06.018
Abstract: Although primary care nurse and allied health clinician consultations represent key opportunities for the provision of preventive care, it is provided suboptimally. To assess the effectiveness of a practice change intervention in increasing primary care nursing and allied health clinician provision of preventive care for four health risks. Two-group (intervention versus control), non-randomized controlled study assessing the effectiveness of the intervention in increasing clinician provision of preventive care. Randomly selected clients from 17 primary healthcare facilities participated in telephone surveys that assessed their receipt of preventive care prior to (September 2009-2010, n=876) and following intervention (October 2011-2012, n=1,113). The intervention involved local leadership and consensus processes, electronic medical record system modification, educational meetings and outreach, provision of practice change resources and support, and performance monitoring and feedback. The primary outcome was differential change in client-reported receipt of three elements of preventive care (assessment, brief advice, referral/follow-up) for each of four behavioral risks in idually (smoking, inadequate fruit and vegetable consumption, alcohol overconsumption, physical inactivity) and combined. Logistic regression assessed intervention effectiveness. Analyses conducted in 2013 indicated significant improvements in preventive care delivery in the intervention compared to the control group from baseline to follow-up for assessment of fruit and vegetable consumption (+23.8% vs -1.5%) physical activity (+11.1% vs -0.3%) all four risks combined (+16.9% vs -1.0%) and for brief advice for inadequate fruit and vegetable consumption (+19.3% vs -2.0%) alcohol overconsumption (+14.5% vs -8.9%) and all four risks combined (+14.3% vs +2.2%). The intervention was ineffective in increasing the provision of the remaining forms of preventive care. The intervention's impact on the provision of preventive care varied by both care element and risk type. Further intervention is required to increase the consistent provision of preventive care, particularly referral/follow-up.
Publisher: Wiley
Date: 31-05-2016
DOI: 10.1111/JPC.13252
Abstract: Despite ongoing investments to improve the obesogenic environments of childcare settings, little is known regarding how these services have changed their physical activity and nutrition-promoting practices. This study aims to describe changes in the proportion of Australian childcare services that have adopted best-practice healthy eating and physical activity practices between 2006 and 2013 and to assess whether adoption varied by socio-economic status and locality. A randomly selected s le of nominated supervisors (n = 358) from childcare services located in New South Wales, Australia, participated in a telephone survey in 2006, 2009, 2010 and 2013. Supervisors reported on their service's adoption of six practices: (i) having written nutrition and physical activity policies (ii) staff trained in physical activity and nutrition in the past year (iii) scheduled time for fundamental movement skills and (iv) outdoor play (v) weekly or less screen time opportunities and (vi) serving only non-sweetened beverages. A significant increase in the prevalence of services adopting all but one practice, between 2006 and 2013 was identified. Ninety one percent of services adopted four or more practices, a significant increase from 38% in 2006. There were no differences in the proportion of services adopting each practice by locality and socio-economic status. Government investment in obesity prevention programmes can equitably improve childcare service's adoption of healthy eating and physical activity promoting practices on a jurisdiction-wide basis. The establishment of a routine system to monitor adoption of a broader range of practices by childcare services is warranted.
Publisher: BMJ
Date: 17-04-2015
Publisher: Elsevier BV
Date: 03-2014
Abstract: Telephone-based interventions can be effective in increasing child fruit and vegetable intake in the short term (<6 mo). The long-term efficacy of such interventions, however, is unknown. The primary aim of this study was to determine whether the short-term (<6 mo) impact of a telephone-based intervention on children's fruit and vegetable intake was sustained over a longer term. A secondary aim of the study was to assess the long-term impact of the intervention on the intake of foods high in fat, salt, or sugar (noncore foods). The study used a cluster randomized controlled trial design. Parents were recruited from Australian preschools between February and August 2010 and allocated to receive an intervention consisting of print materials and 4 telephone-counseling calls delivered over 1 mo or to a print information-only control group. The primary endpoint for the trial was the 18-mo postbaseline follow-up. Linear regression models were used to assess between-group differences in child consumption of fruit and vegetables and noncore foods by subscales of the Children's Dietary Questionnaire. Fruit and vegetable subscale scores were significantly higher, indicating greater child fruit and vegetable intake, among children in the intervention group at the 12-mo (16.77 compared with 14.89 P < 0.01) but not the 18-mo (15.98 compared with 16.82 P = 0.14) follow-up. There were no significant differences between groups at either of the follow-up periods in the noncore food subscale score. Further research to identify effective maintenance strategies is required to maximize the benefits of telephone-based interventions on child diet.
Publisher: Wiley
Date: 04-07-2018
DOI: 10.1111/JPC.14106
Abstract: To describe parent-reported child: (i) sleep duration (ii) sleep quality (iii) sleep hygiene practices and (iv) the proportion of children meeting sleep duration recommendations. A convenience s le of parents of Australian pre-school-aged children (3-5 years) were surveyed from the Hunter New England region of New South Wales. The cross-sectional survey was conducted via computer-assisted telephone interview. The survey assessed parent and child demographic characteristics and parent-reported child sleep duration, quality and sleep hygiene practices. A total of 488 eligible parents or guardians took part in the study. Parents reported that children slept an average of 11.03 h per night. Approximately 96% of children met daily sleep duration recommendations from sleep guidelines for their age group. The majority of parents reported that their child had 'good' sleep quality (86.89%). Almost 40% reported that their child woke at least once a night. Sleep hygiene practices were relatively well established however, a small proportion of parents indicated that they had no rules surrounding bedtime (13.52%) or television use before bed (14.52%). The current study describes the sleep duration, quality and sleep hygiene practices of a s le of pre-school-aged children in New South Wales, Australia. Future research using objective measures of sleep duration and hygiene, as well as assessing a broader spectrum of sleep hygiene practices, is needed.
Publisher: Wiley
Date: 12-10-2023
DOI: 10.1002/HPJA.820
Publisher: Wiley
Date: 04-2020
DOI: 10.1002/HPJA.268
Abstract: Supporting centre-based childcare services to create physical activity (PA) environments is a recommended strategy to improve child PA. This study aimed to describe the implementation of PA policies and practices by these services, and to examine the associations with service characteristics. Nominated supervisors of childcare services (n = 309) in the Hunter New England region, New South Wales, Australia, completed a telephone interview. Using previously validated measures, the interview assessed the implementation of evidence-based practices shown to be associated with child PA. This includes: (a) provision of active play opportunities, (b) portable play equipment availability, (c) delivery of daily fundamental movement skills, (d) having at least 50% of staff trained in promoting child PA the past 5 years and (e) having written PA and small screen recreation policies. Although 98% (95% CI 96, 99) of childcare services provided active play opportunities for at least 25% of their daily opening hours, only 8% (95% CI 5, 11) of services fully implemented all policies and practices with no service characteristic associated with full implementation. Long day care service had twice the odds of having a written PA policy (OR 2.0, 95% CI 0.7, 5.8), compared to preschools (adjusted for service size, socio-economic disadvantage and geographical location). Improvements could be made to childcare services' operations to support the promotion of child PA. SO WHAT?: To ensure the benefits to child health, childcare services require support to implement a number of PA promoting policies and practices that are known to improve child PA.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-12-2011
Publisher: JMIR Publications Inc.
Date: 16-12-2021
Abstract: ew translational trials have provided detailed reports of process evaluation results. his study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. ixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at i P /i & .05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. ata were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention however, more participants actively withdrew from the telephone intervention. his is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
Publisher: BMJ
Date: 06-2017
Publisher: JMIR Publications Inc.
Date: 07-2021
Abstract: chool food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. his study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. his cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as i everyday /i , i occasional /i , and i caution /i ) were assessed over an 8-week period at baseline and 18-month follow-up. n all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ 95% CI [–124.7, –23.4] i P /i =.006) and saturated fat (–0.4 g 95% CI [–0.7, –0.1] i P /i =.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing i everyday /i items increased significantly (odds ratio [OR] 1.2 95% CI [1.1, 1.4] i P /i =.009, corresponding to a +3.8% change) and the odds of purchasing i caution /i items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9] i P /i =.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. his is the first study to investigate the i sustained /i effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally however, more research is required. ustralian New Zealand Clinical Trials Registry ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075
Publisher: Elsevier BV
Date: 12-2014
Publisher: Elsevier BV
Date: 06-2015
Abstract: To describe children's physical activity levels during childcare and associations with modifiable characteristics. A cross-sectional study of 328 preschool children (43% girls age 3-5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four-year-olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Written physical activity policy, structured staff-led physical activity and staff joining in active play were associated with higher levels of physical activity. Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.
Publisher: American Psychiatric Association Publishing
Date: 08-2015
DOI: 10.1176/APPI.PS.201400360
Abstract: Compared with the general population, people with a mental illness have a greater prevalence of behaviors that contribute to higher chronic disease rates. Mental health clinical guidelines recommend preventive care to address such behaviors however, little information is available about whether clients consider preventive care acceptable or about the prevalence of such care in mental health services. This article describes acceptability and receipt of assessment, advice, and referral for smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and physical inactivity, as reported by community mental health service clients. The association between preventive care, diagnosis, and number of clinical appointments was examined. A cross-sectional telephone interview was conducted with clients (N=558) of community mental health services in Australia. Although preventive care was highly acceptable to clients (86%-97%), receipt of preventive care was low. Client receipt of risk assessment ranged from 26% (assessment of fruit or vegetable intake) to 76% (assessment of alcohol consumption). The proportion of clients at risk of and assessed for unhealthy behavior who then received brief advice ranged from 69% (fruit or vegetable intake) to 85% (physical activity), whereas only 38% (alcohol consumption) to 49% (smoking) received any referral. A greater number of mental health appointments were associated with higher prevalence of preventive care, as were diagnoses of diabetes or respiratory conditions and not having a schizophrenia diagnosis. Practice change strategies are required to increase the delivery of routine preventive care within mental health services if clients are to benefit from clinical guidelines.
Publisher: BMJ
Date: 02-06-2015
No related grants have been discovered for Luke Wolfenden.