Objectives and importance of studyThe aim of this scoping review was to: (1) consolidate the barriers and enablers to allied health service use for type 2 diabetes (T2D) management, and (2) identify knowledge gaps and priorities to inform future research and policy development.MethodsThis scoping review has been reported in accordance with the PRISMA for Scoping Reviews guidelines. Electronic databases, including Medline, Scopus, Web of Science, INFORMIT, and Cumulative Index to Nursing and Allied Health were searched from 1 January 2005 to 18 April 2025 for relevant articles. Peer-reviewed articles investigating barriers and enablers to allied health service use for T2D management in Australia were included. Barriers and enablers influencing: (1) patient utilisation of services, (2) General practictioner (GP) referral to services, and (3) allied health practitioners’ delivery of services were extracted and categorised according to the Theoretical Domains Framework (TDF).ResultsA total of 44 articles (43 studies) were included. A total of 32 themes were identified across 11 TDF domains. Key barriers to service use included limited available services, workforce shortages, long wait lists, high out-of-pocket costs, a lack of GP referral, and limited patient and GP awareness of the role and value of allied health services. Enablers included person-centred care and culturally tailored service delivery. The Medicare Chronic Disease Management scheme was identified as both an enabler (facilitating use of and referral to services) and a barrier (limiting utilisation and delivery of services due to inadequate rebates and session caps). Few studies examined differences in barriers and enablers by age group or sex.ConclusionsThis review identifies opportunities to strengthen multidisciplinary primary care management of T2D. Barriers and enablers to allied health service use are multifaceted, and addressing them will require targeted policy action, including workforce investment, a redesign of the Medicare Chronic Disease Management scheme, new integrated models of care and enhanced practitioner training. Future research should explore sociodemographic disparities in service use to inform equitable service delivery.
Objectives and importance of the studyThe aims of this study were to examine trends in the annual rate of smoking cessation medicines (SCMs) supplied to Aboriginal and Torres Strait Islander people who smoke using dispensings by Services Australia from 2006 to 2019, and to assess whether the provision of SCMs varies between regions supported by a Tackling Indigenous Smoking (TIS) program and those without TIS funding.Study typeCross-sectional study; analysis of administrative data.MethodsPharmaceutical Benefits Scheme (PBS) and Section 100 Remote Area Aboriginal Health Services (RAAHS) claims data for SCMs supplied to Aboriginal and Torres Strait Islander peoples were analysed. Annual rates of claims per 100 Aboriginal and Torres Strait Islander persons who smoke were calculated. The change in rate of dispensing between 2006 and 2019 was assessed using linear regression, and the patterns in the number of dispensings in TIS and non-TIS areas were described over time.ResultsFrom 2006 to 2019, 470,408 and 7413 SCMs were dispensed under the PBS and under the RAAHS program, respectively. Overall, the rate of dispensings per 100 Aboriginal and Torres Strait Islander persons who smoke increased from 1.24 in 2006 to 18.08 in 2019 for PBS (P < 0.001), and from 0.30 in 2006 to 1.70 in 2019 for RAAHS (P < 0.001). From PBS data, the Australian Capital Territory dispensed SCMs at the highest rate (1.50 in 2006 to 27.38 in 2019), and the Northern Territory the lowest (0.23 in 2006 to 3.41 in 2019). Overall, a greater number of dispensings were observed in TIS-funded areas, with 83% of PBS dispensings occurring in these areas. However, rates could not be calculated for TIS and non-TIS comparisons due to limited denominator data.ConclusionsUptake of SCM by Aboriginal and Torres Strait Islander people who smoke increased significantly between 2006 and 2019 (1.24–18.08 for PBS and from 0.30 to 1.70 for RAAHS per 100 people), with a greater number of dispensings observed in areas serviced by a TIS team. Access to medicines to support quitting attempts is an important component of comprehensive tobacco control and may assist people to successfully quit.
Objectives and importance of studyThe use of community score cards (CSC) in collaboration with local organisations and the health sector is a novel approach to improving the performance of reproductive, maternal, newborn and child health (RMNCH) services. The goal of the New Partnership Initiative Expand (NPI) program was to increase the availability and demand for high-quality, high-impact RMNCH services in rural Ethiopia.MethodsAn independent evaluation of the NPI program was completed in 2024 using a mixed-methods evaluation design. The CSC process engaged 355,220 community representatives and 1557 client councils. The quantitative data included routine service delivery data extracted from Ethiopia’s District Health Information System, baseline versus end-of-project CSC standards of care, RMNCH indicators and measures of organisational capacity. The qualitative data included 69 in-depth interviews, 27 focus group discussions with 218 community participants, and interviews with local organisations, health officials, client councils and CSC administrators.ResultsThe mean CSC scores and standard deviations were 47.2 ± 11% at baseline, 67 ± 6.6% at midterm and 72.3 ± 7.6% at endline. The RMNCH scores were 58% for contraceptive acceptance rate (CAR), 59% for antenatal care (ANC) and 76% for postnatal care (PNC) at baseline, and 71% for CAR, 65% for ANC and 80% for PNC at endline. Applying paired t- and Z-tests, we found a statistically significant difference in CSC and RMNCH scores over time (P < 0.000 in all cases). The self-reported indicators used to measure the organisational and technical capacity to conduct the CSC processes increased by 12%.ConclusionsThe inclusion of local organisations in the CSC process led to increased measures of community engagement, positive perceptions of health system standards of care and improvements in organisational capacity. Health worker responsiveness and increased utilisation of RMNCH services also increased. We recommend efforts to further engage local organisations in the application of CSCs in low- and middle-income countries, and expansion by the Ministry of Health in Ethiopia.
Objectives and importance of studyPharmacist-administered vaccinations improve access and coverage globally, including in Australia; however, a nationally harmonised regulatory framework is lacking. This review compares policies and legal frameworks for pharmacist-administered vaccinations to children and adolescents across Australian jurisdictions, identifying areas for improvement nationally and internationally.Study typeNarrative review.MethodsPolicies and legislation on pharmacist-administered vaccination were compared using three priority themes consistent with the Australian Scope of Practice Review: legislation and regulation, funding and payment policy, and workforce design, development, education and planning. Peer-reviewed and grey literature were included, including guidelines, policy frameworks, standards, and legislation published or observed up to 22 March 2026, with no start date restrictions. Websites of pharmacy organisations, health departments and vaccination programs relevant to pharmacist-administered vaccinations for children and adolescents in Australia were searched.ResultsPolicies for pharmacist-administered vaccinations vary across jurisdictions. Legislation and regulation: Queensland and South Australia allow vaccinations for all age groups. The Australian Capital Territory, New South Wales, Tasmania and Western Australia permit vaccination from 5 years of age, with influenza vaccination permitted from 2 years, whereas the Northern Territory and Victoria restrict all vaccinations, including influenza, to children aged ≥5 years. Funding and payment policy: despite the National Immunisation Program, state-funded programs differ in vaccine coverage and eligibility, with out-of-pocket costs for non-National Immunisation Program vaccine administration. Workforce design, development, education and planning: training requirements align nationally, but workforce development and integration into public health initiatives differ by jurisdiction.ConclusionsThe evolution of pharmacist-administered vaccination in Australia highlights the need for consistent regulations, funding models, and workforce integration to ensure safe and accessible services. These findings can inform policymakers where pharmacist-led vaccination is emerging, emphasising collaboration with healthcare professionals and pharmacy organisations to improve vaccination rates among children and adolescents.
The involvement of people with lived experience is essential to the development of policies, programs and research that reflect the needs and priorities of the communities they serve. Although this principle is well established, achieving meaningful community engagement in practice remains challenging. Drawing on experiences at Cancer Council Australia, we describe key successes and learnings in embedding lived experience within policy development processes, using the ‘Empowerment Gradient’ as a guiding framework for the analysis. Tailored engagement approaches, clear communication, multiple feedback pathways and remuneration for people’s time supported deeper involvement consistent with co-production. However, system-level constraints, including limited time, resources and organisational capacity, continue to limit opportunities for community control, highlighting the need for sustained leadership and structural investment. Our reflections reinforce international guidance emphasising that different engagement approaches are needed for different contexts and levels of sensitivity. We argue that genuine, respectful and well-supported involvement of people with lived experiences must be prioritised across the health system, and we offer insights to support researchers, policymakers and program managers seeking to strengthen the safety, legitimacy and impact of lived experience engagement in their work.
Delirium is a common health problem with serious and long-lasting health consequences that disproportionately affects vulnerable population groups (especially older people with dementia or frailty). Multicomponent, non-pharmacological interventions can prevent up to half of hospital-acquired delirium cases, but these interventions are poorly prioritised, hindered by upstream factors across the health system. This perspective examines the broader health system, policy and social contexts that have limited recognition of delirium as a public health priority in Australia, calling for urgent policy reform to address preventable harm, reduce inequities and strengthen healthy ageing outcomes.
OBJECTIVES AND IMPORTANCE OF STUDY:This study aimed to examine the extent to which residential ambient air pollution across Australia, globally a relatively low-pollution setting, is associated with cardiovascular and respiratory hospitalisations. STUDY TYPE:A national, cross-sectional, ecological study. METHODS:This whole-of-population study used national air pollution estimates from 2016 and administrative hospitalisation data aggregated across 1155 public health areas from 2016 to 2017, representing 23,236,046 of the Australian population. Population-weighted median concentrations from 2016 of particulate matter ≤2.5 µm (PM2.5; 6.4 µg/m3) and nitrogen dioxide (NO2; 4.4 ppb) were estimated using validated satellite-based land use regression models. Cardiorespiratory hospitalisations (June 2016 to June 2017) were sourced from national administrative data from all hospitals for each public health area. Incidence rate ratios for hospitalisations were estimated for an interquartile range increase in each air pollutant using mixed regression models (age-standardised, adjusted for obesity, smoking, rural/urban and disadvantage) stratified by sex. The population-attributable fraction for each pollutant was estimated across ideal exposure scenarios (5th, 10th and 25th percentile of each pollutant) at each public health area. RESULTS:PM2.5 and NO2 exposure were consistently associated with greater hospital admissions for cardiovascular and respiratory diseases across both males and females, with estimated incidence rate ratios ranging from 1.02 to 1.06. Across both pollutants, estimated population attributable fractions ranged from 0.9 to 3.9% for cardiovascular diseases, and 1.8 to 7.5% for respiratory diseases. CONCLUSIONS:Despite Australian air pollution levels being relatively low compared with other countries, we observed consistent associations with cardiorespiratory hospitalisations. Given the mounting evidence that air pollution negatively impacts cardiorespiratory health, policies should continuously target air pollution reduction.
OBJECTIVES AND IMPORTANCE OF STUDY:This study aimed to identify short message service (SMS) reminder content perceived as most likely to prompt bowel cancer screening, examine differences across sociodemographic subgroups, and explore preferences for timing and frequency. METHODS:Australian residents (N = 1016) aged 50-74 years completed an online survey rating five SMS reminders presented in random order. Outcomes included perceived usefulness, likelihood of encouraging kit return, likelihood of irritation and clarity. Preferences for timing and frequency were also assessed. Bayesian multilevel modelling (cumulative probit) compared ratings across SMS types, with effect sizes expressed as standard deviation (s.d.) differences in perceived likelihood that each SMS would encourage kit return compared with a reminder-only message. Interactions with age, gender, socioeconomic status and screening history were explored. RESULTS:Compared with a 'reminder-only' message, SMS content that encouraged storing the kit near the toilet (s.d. 0.44), conveyed general practitioner endorsement (s.d. 0.32) and gave instructions (s.d. 0.22) was more likely to prompt kit return. Responses varied slightly by age and area-level socioeconomic status. Most participants preferred two to three SMS reminders (mean 2.89, s.d. 6.73). CONCLUSIONS:SMS reminders using behavioural prompts and clear, concise content may support improved screening participation. Tailored SMS messages that reflect public preferences may increase kit return rates, support national screening goals and reduce bowel cancer mortality.
OBJECTIVES:Recognising the need to address high rates of smoking within priority populations, the Cancer Council New South Wales launched the 'Tackling Tobacco' program in 2006. This program aims to reduce tobacco-related disparities among groups experiencing social and economic disadvantage in the state of New South Wales (NSW). After almost 20 years of implementation, this paper describes the development, implementation, evaluation and national scale up of the Tackling Tobacco program. TYPE OF PROGRAM:The Tackling Tobacco program uses an organisational change model to embed evidence-based smoking cessation support within community service organisations (CSOs) which provide services to priority populations across Australia. The program comprises six core elements: committed leadership, comprehensive smoking policies, supportive systems, training and follow up, monitoring and data, and consistent quit support. METHODS:A desktop review of pre- and post-project surveys and annual reports was conducted and used alongside the published evidence from the Tackling Tobacco research team to describe the implementation and impact of the program from 2006 to current. This paper presents data from the 2015-2024 annual reporting periods, supplemented with data collected as part of annual reports from the program's inception in 2006. RESULTS:Since its 2006 inception, the Tackling Tobacco program has partnered with 252 CSOs across NSW, training a total of 4580 CSO staff, and reaching 21,648 clients who smoke. Since 2021 (when client-level indicators began to be measured as part of routine evaluation), 3001 clients had their smoking status assessed. Of these clients, 661 accessed nicotine replacement therapy, 214 received Quitline referrals, 295 received referrals to a clinician, and 1432 received behavioural strategies and written support information. LESSONS LEARNT:Trusted partnerships and the active involvement of research end-users from program inception to implementation are essential for change at a practice and sector level. Community-based health promotion programs should be built on the highest level of research evidence. Achieving change and impact, particularly at a population level aimed at reducing disparities, requires leadership, resourcing and commitment.
Objectives and importance of study Given the limited research on anti-racism interventions in healthcare, this study examined the effectiveness of bystander intervention training in the context of a comprehensive, multi-pronged approach to bystander anti-racism intervention for healthcare staff in one local health district in Sydney, Australia.Study type Pre-post-follow-up study.Methods Data were collected over 2 years (January 2021 to February 2023), at three time points through an online survey. Supplementary data were also obtained from the public sector's state annual employee experience survey.Results The results showed that the training improved staff's understanding of racism and its impacts on health, increased their confidence and likelihood to respond to a racist incident at work, and increased their feelings of being supported by their workplace and/or manager to respond to an act of racism. Most staff were satisfied with the training, found it useful and would recommend it to colleagues. Supplementary data from the state annual employee experience survey showed that reported racism decreased slightly, and overall satisfaction with how their reported racism experience was handled more than doubled.Conclusions The local health district developed and evaluated the effectiveness of its comprehensive, multi-pronged Addressing Racism in Healthcare Strategy. The strategy included the foundational principles and strategies for effective anti-racism interventions in healthcare settings: laying the foundation for the anti-racism intervention, addressing institutional racism and addressing personally-mediated racism. The Addressing Racism in Healthcare Strategy is a successful model that other health districts can adapt to promote inclusivity and cultural safety across the broader health system.
OBJECTIVES AND IMPORTANCE OF STUDY:This study aimed to document trends in lead screening rates and blood lead levels among children residing in Broken Hill aged <5 years at an Aboriginal Community Controlled Health Organisation since beginning screening in 2011. METHODS:This was a repeat cross-sectional descriptive analysis of lead screening program data. Data were extracted from the New South Wales Health lead database for all blood lead screening tests among children residing in Broken Hill aged 5-59 months undertaken by Maari Ma Health Aboriginal Corporation, 2011-2022. Key outcomes were annual screening coverage, age-standardised annual geometric mean blood lead levels and categorical distribution of blood lead levels. RESULTS:The number of Indigenous children aged 1 to <5 years screened annually increased from 58 in 2010 to 171 in 2012. Average lead screening coverage in children aged <5 years in 2012-2020 was 78% (range 71-82%). In 2021-2022 during the COVID pandemic, screening coverage declined to 50%. Average lead levels in children screened at Maari Ma have remained unchanged over the past 10 years. Over 70% of these children record a blood lead level over the current National Health and Medical Research Council level of concern of 5 μg/dL. CONCLUSIONS:Screening of Indigenous children increased substantially following Maari Ma's involvement in the lead screening program. We suggest this reflects the effectiveness of Aboriginal Community Controlled Health Organisation involvement in mainstream program delivery to improve engagement with Indigenous communities. Despite high lead screening coverage and a AU$13 million state government investment to address elevated blood lead levels in Broken Hill since 2015, the majority of Indigenous children residing in Broken Hill continue to record a blood lead level above the National Health and Medical Research Council level of concern, and average blood lead levels in this population remained unchanged over the past 10 years. This suggests that current measures are not working for this population, with the lack of lead-safe housing for Indigenous families being the key driver. More comprehensive strategies specifically targeting Indigenous children are required to close the gap in the disproportionate burden of lead in Broken Hill.
Health and medical journals have a mission to evaluate and disseminate information generated from rigorous and peer reviewed scientific enquiry. As journal editors, we are entrusted with safeguarding the integrity of the scientific record, supporting the researchers who advance discovery, and honoring the excellence of academic institutions that cultivate rigorous and unbiased inquiry. Maintaining the integrity of the information published in our journals helps ensure that scientists, health professionals, policymakers and the public can benefit from information that is accurate, trustworthy, accessible, and understandable.
OBJECTIVES AND IMPORTANCE OF STUDY:Melanoma of the skin is highly preventable, with >97% of cases in Australia/New Zealand caused by overexposure to ultraviolet radiation. Young adults aged 18-24 years are at greater risk of overexposure than older adults due to lower use of some forms of sun protection, spending more time in the sun, and being more likely to attempt tanning and experience sunburns. This paper covers the extensive research undertaken to develop and evaluate a new skin cancer prevention campaign to improve sun protection among young adults in New South Wales, Australia. METHODS:Underpinned by a customised theory of change logic model, campaign development was informed by qualitative formative research (ethnographic immersions and focus groups, n = 56), concept testing (online interviews, n = 70) and pre-testing (online survey, n = 416) with 18-24-year-olds. Campaign effectiveness was evaluated through the Cancer Institute NSW Skin Cancer Online Tracking Survey (n = 927 18-24-year-olds). RESULTS:Building on formative qualitative research into sun protection barriers and enablers, concept testing identified the need to depict ultraviolet radiation as a credible threat that evokes fear of immediate harm across diverse settings. It also highlighted the importance of showing young adults using effective sun protection behaviours. Online pre-testing revealed the importance of imagery being motivating, but not overly confronting. Evaluation of the 2023/2024 campaign found that young adults' self-reported campaign exposure was associated with greater concern about developing melanoma (74%, vs 64% of non-recognisers, P < 0.05), and greater intention to adopt sun protection behaviours (wear a hat (72%, vs 65%, P < 0.05), wear a wide-brimmed hat (32%, vs 22%, P < 0.05) and wear clothing that protects skin (64%, vs 57%, P < 0.05)). CONCLUSIONS:Iterative qualitative and quantitative research provided valuable learnings to inform, develop, enhance and evaluate the Cancer Institute NSW's If You Could See UV skin cancer prevention campaign.
OBJECTIVES:To explore healthcare workers' perceptions of the response to a hospital-based COVID-19 outbreak early in the pandemic, to inform preparedness for future responses. STUDY TYPE:Qualitative cohort survey. METHODS:Four months post-outbreak, 252 healthcare workers responded to one or more open-ended questions regarding their perceptions of the response. RESULTS:Five broad themes were identified through qualitative content analysis: (1) communication in a context of uncertainty and rapid change; (2) infection control practices, including availability, adequacy and access to personal protective equipment; (3) staff dedication and mutual support in extraordinary circumstances; (4) appropriateness of outbreak response; and (5) staff vulnerability. An additional two issues cut across these themes: a sense of variability between clinical areas, organisations and work groups in relation to communication and approach to infection prevention and control practices; and an acknowledgement that the response to the outbreak was constrained by assumptions that reflected the state of understanding of SARS-CoV-2 transmission and outbreak management at that time. CONCLUSIONS:Healthcare workers who experienced an early hospital-centred COVID-19 outbreak in regional Tasmania, Australia, highlighted the need for enhanced preparedness in terms of infection control training and personal protective equipment availability, adequacy and access for future outbreaks. Planning for a successful future pandemic response also should include emergency communication preparedness, planning for effective communication in a multi-institutional healthcare campus in a situation of constant uncertainty. Staff resilience and commitment should be celebrated and reinforced as assets for future responses, while ensuring recommendations for changes to planning and practice stemming from the outbreak are implemented.
OBJECTIVES AND IMPORTANCE OF STUDY:To evaluate the effectiveness of training workshops aiming to improve researchers' consumer and community involvement (CCI)-related awareness, attitudes and behaviours, and capture remaining barriers to CCI. STUDY TYPE:Cross-sectional questionnaires. METHODS:Participants consisted of University of Queensland researchers attending a CCI training workshop facilitated by The Kids Institute between 2017 and 2023. Participants were invited to complete two surveys with multiple-choice and open-field items: (i) short-term evaluation immediately following workshop attendance to capture reactions, and (ii) long-term evaluation up to 6 years following attendance, including retrospective and current perceptions of confidence, motivation, capability, opportunity and reported behaviours. Survey items mapped to the Kirkpatrick model for training evaluation (reaction, learning, behaviour and results) and the capability, opportunity and motivation model of behaviour change (COM-B). Multiple-choice responses were summarised with descriptive statistics and Chi-squared analysis, whereas open-field responses were mined qualitatively with content analysis. RESULTS:A total of 17 out of 183 and 104 out of 240 individuals completed/partially completed Surveys 1 and 2, respectively. Survey 1 comments captured satisfaction with content and facilitation, and improved learning (Kirkpatrick's 'reaction' and 'learning'). Most Survey 2 participants were satisfied/highly satisfied with the workshop (n = 82/101, 81%), and agreed that CCI was relevant (n = 88/90, 98%) or valuable (n = 86/89, 97%) to their research (COM-B 'motivation'). When completing Survey 2, a minority (n = 17/90, 19%) felt they were confident/very confident in implementing CCI before the workshop, which increased significantly post-workshop (n = 54/89, 61%; P < 0.05). Participants reported moderate to high levels of capability (n = 78/83, 94%) and capacity (n = 73/83, 88%) implementing CCI. The proportion of researchers implementing CCI in their research increased from 65% (n = 59/91) to 78% (n = 71/91) in the months/years post-workshop (P < 0.05). Researchers reported consistent CCI throughout the research journey and diverse models of involvement. Participants identified financial and administrative institutional barriers to optimal CCI implementation in research. These results align with all elements of the Kirkpatrick and COM-B models. CONCLUSIONS:CCI training improved researchers' CCI-related awareness, confidence and behaviours. However, the remaining barriers to optimal CCI implementation included logistical and institutional barriers, reflecting the opportunity element of COM-B. Thus, although CCI training of researchers is valuable and effective, institutions need to capitalise on these benefits with administrative and financial support.
Adolescence is characterised by profound physical, mental and social transformations that affect health across the life course.(1) Reducing non-communicable diseases (NCDs) is a key component of the Sustainable Development Goals,(2) with adolescence widely recognised as the critical period when risk factors for NCDs start to emerge. However, adolescence is less well appreciated as a period of risk of death from NCDs. Despite NCDs being acknowledged as a growing challenge among Australian adults,(3) the lack of published recent evidence and cause trends in NCD mortality among Australian adolescents hampers prevention efforts in this important life stage. Reducing the NCD burden is also central to closing the life expectancy gap faced by Aboriginal and/or Torres Strait Islander peoples,(4) which similarly requires characterising the fatal burden in Aboriginal and Torres Strait Islander adolescents. We aimed to characterise and describe the incidence of deaths caused by NCDs among adolescents in Australia from 2001 to 2019.
OBJECTIVES:Exposure to unhealthy food and alcohol advertising in childhood and adolescence can influence preferences and later consumption. A fragmented and ineffective network of regulations and guidelines covers outdoor advertising of alcohol to children in Victoria, and regulations for unhealthy food/non-alcoholic drinks are even less comprehensive. The aim of this study was to quantify the prevalence, size, and youth appeal of unhealthy food and drink (including alcohol) marketing at a major public transit hub in Melbourne: Southern Cross Station. This location is not subject to the Department of Transport and Planning rules regarding placement of unhealthy product marketing that apply to other public transport in Victoria. METHODS:A manual audit of all advertisements located inside Southern Cross station (including on internal walls, hanging from the ceiling, freestanding on concourse, walkways and platforms) took place over 4 days in June and July 2024. From photographs, researchers categorised all advertisements as either alcohol, food/non-alcoholic drink (and then as either unhealthy [discretionary] or healthy [core, based on Australian Dietary Guidelines]), or other; and coded the size of the advertisement. Food/drink (including alcohol) advertisements were coded for the presence of features with youth appeal using a validated measure. A total advertising power score for youth appeal was calculated. Mann-Whitney U-tests examined differences in size and youth appeal between categories. RESULTS:A total of 858 advertisements were identified: n = 213 (24.8%) were for food/non-alcoholic drinks (most of which were unhealthy, 83.1%), and n = 202 (23.5%) were for alcohol. Alcohol advertisements were significantly larger than both non-alcoholic drink and food/non-alcoholic drink advertisements combined (each P < 0.0001), and had a significantly higher number of features with youth appeal and a higher youth appeal score than both non-alcoholic drinks and food/non-alcoholic drinks combined (all P < 0.05). Youth appeal was also significantly higher for unhealthy than healthy food/non-alcoholic drink advertisements (P = 0.039). CONCLUSIONS:Advertisements for unhealthy food and drink, including alcohol, at Southern Cross station are prevalent, prominent and powerful in their potential appeal to youth. A coherent and comprehensive approach to regulating the content of advertising on public transport and in outdoor spaces is needed to protect children and adolescents.
OBJECTIVES AND IMPORTANCE OF STUDY:In recognition of the contribution that consumers can make to research, the Australian National Health and Medical Research Council has called for the 'active involvement of consumers and community members in all aspects of health and medical research'. However, there are very few publicly available, easy-to-understand, co-designed resources that are targeted towards helping diverse consumers learn about specific research methods. The aim of this project was to co-design health literacy-informed, plain language guides for qualitative and (quantitative) survey research. STUDY TYPE:Multi-phase participatory co-design study. METHODS:This project was underpinned by consumer engagement principles (respect and equity; trust; empowerment) and followed the New South Wales Health's Agency for Clinical Innovation's four co-design steps (Engage; Gather; Understand; Improve). The co-design team comprised people with experience in qualitative and survey research, including members of the Sydney Health Literacy Lab's community panel. The project involved a series of online workshops to discuss each research method and learn from lived experience. Insights from the workshops informed drafts of the guides, which were iteratively revised with ongoing feedback. Health literacy resources, including the Health Literacy Editor (assessing grade reading score, complex language, and passive voice) and the Patient Education Materials Assessment Tool (assessing understandability and actionability), were then applied to assess each guide. RESULTS:The two guides provide foundational knowledge about each research method, such as what research questions qualitative and survey research can answer, the types of data collected, and the types of analyses undertaken. Content provides clear examples of how consumers can be involved at each stage of the research process and best practice activities. The guides incorporate health literacy strategies where possible (Grade 9 reading level; 84% understandability and 83% actionability). DISCUSSION AND CONCLUSION:Through an iterative co-design process, we have developed research guides that seek to build consumers' capacity to engage more deeply in any given project, throughout the research process. They are positioned to support more equitable consumer engagement that better reflects the diversity of the communities we serve, including those with diverse health literacy needs.
