The underlying tenet of evidence-based decision-making in health services is assessing all the relevant evidence. Using the traditional qualitative and quantitative approaches to identifying evidence may not capture the full spectrum of factors that need to be addressed. A selective mixed-method approach may provide a comprehensive assessment of the relevant knowledge. This paper adds to the methodological literature by outlining a novel sequential, mixed-method, exploratory process for identifying evidence-based data standards that may be used for health service decision-making. The three-phase process, entitled Delphi Plus, engages peer-nominated topic-specific experts to assess all publicly available and practice-based items and, through a series of reviews, reach an evidence-based consensus on standards for decision-making. Each process phase is outlined in-depth and supplemented by practical learnings gained through its implementation. The Delphi Plus methodology provides the first comprehensive process for combining the published and practised data to develop evidence-based data standards. The routine use of Delphi Plus would provide a framework for benchmarking in health services, enabling greater monitoring and evaluation of client outcomes and improving quality care. This manuscript describes the process of implementing Delphi Plus and provides an example of data standards generated from its use, which directly inform the Australian Government's Primary Health Care 10 Year Plan.

Since the declaration of the "war on obesity," there have been many attempts to curb the so-called "obesity epidemic." Indeed, anti-obesity campaigns communicating a "fat-as-fatal" message have become a regular and accepted public health strategy in most economically developed countries. Despite their ubiquity, a growing number of researchers have critiqued the ways these campaigns frame obesity as a health issue and promote problematic weight-loss methods. Nevertheless, such critiques have had little impact on the most highly funded, government-sanctioned interventions on people's bodies. In this chapter, we consider why critical perspectives on obesity have not been more influential in public health practice. To this end, we focus on the Australian anti-obesity campaign, Healthier. Happier. – which sought to deliver positive, supportive, health promotion messages about body weight – and ask how, if at all, this campaign was different from its "fat-as-fatal" predecessors. We begin this task by reviewing existing critiques of mainstream anti-obesity campaigns.

A man’s transition into the role of a father is a rewarding yet challenging experience for many men. This study explores how men navigate contradictory roles of fatherhood and the impact this has on their identities. Fifteen first-time fathers were interviewed, and their responses were analysed using thematic and discourse analysis tools. Findings revealed that fathers both adhered to and challenge masculine ideals of fatherhood. Men described both traditional and non-traditional roles in their becoming a father, being a father, and navigating fatherhood and manhood. The continuation and contestation of masculine discourses in the experiences of fatherhood was found to influence their involvement with raising children and employment, as well as their relationships. Overall, these findings highlight the uncertainty that shapes modern fathers’ roles and demonstrates how fathers move between both traditional and new fatherhood roles.

Leadership and communication capabilities of federal leaders during crises are imperative to support and guide citizens' behaviors and emotions. The following content analysis examines crisis communication delivered by the Australian Prime Minister (PM), Scott Morrison during the COVID-19 pandemic. Communication delivered over seven months starting from the first reported case of COVID-19 in Australia, was analyzed through a process of coding to identify central organizing crisis communication frames and themes and measured against eleven main themes based on principles of Crisis and Emergency Risk Communication (CERC) recommended by the WHO and US Centers for Disease Control and Prevention. Transcripts were sourced from the PM's official website and 91 communiques were analyzed. Key epidemiological indicators and public health measures were reviewed over timeframe to examine changes in communication over the pandemic. Findings indicated that PM Morrison included many features of CERC within his official messaging. Our analysis revealed that the original framework was limited in its scope to encompass certain messages and thus the allocation of new frames,'public health and medical advice' and 'assuring and commending the public and institutions', allowed for a more thorough analysis of communication during a novel global health pandemic. The temporal analysis demonstrated that the government's policy and communication temporally followed case numbers and relative threat of the virus. This study has provided an in-depth review of CERC during the first phase of the COVID-19 pandemic. New frames and themes for the current CERC framework are suggested which can be transferable to other crises in Australia and other countries.

Drug consumption rooms directly attempt to intervene in and govern the place and time of drug use. Whilst the risk-reducing potentials of these interventions have been thoroughly evaluated, the consumption room literature offers fewer insights into the embodied, affective and situated dynamics that underscore service delivery. In this paper, we take up the notion of atmosphere to explore these dynamics in greater depth. Drawing on 12 months of ethnographic research in a German drug consumption room, we describe the manner in which atmospheres came to pervade and condition service encounters. More than simply providing texture to activities within the consumption room, we show how atmospheres gave rise to a distinct range of bodily capacities and therapeutic effects. Critically, these atmospheric affordances exceeded the risk-reducing objectives of the consumption room to encompass an emergent capacity to find repose, enact respite and foster modes of sociality and care. Our analysis further highlights the contextual contingencies through which the atmospheres of the consumption room emerged, including the efforts of both staff and clients to cultivate and control particular atmospheric qualities. We conclude by considering how closer attention to the atmospheric and affective dimensions of service delivery may challenge how consumption room interventions are enacted, valued and researched. This is to gesture towards a novel, atmospheric mode of harm reduction that has effects by transforming embodied potentials for both staff and clients.

In this chapter, we use Bruno Latour's research on modes of existence to study a public health pedagogy, the Healthier. Happier. campaign, as a technological being. We approached this project with the question of why critical health research is seldom translated into practice by policy makers. Analysing Healthier. Happier. as a technological being drew our attention to the compositional logic of the campaign's existence. This conceptual apparatus provides access to the interpretive key with which to better understand the often opaque and taken-for-granted process of evidence-based practice in public health pedagogies like Healthier. Happier. Latour's work on modes of existence has helped us think about the campaign's existence in ways other theories have not. Ultimately, it has provided the language and thinking tools to consider the possibility of increased engagement with critical public health literature by campaign developers.

This paper attends to the activity of care as it is articulated, enacted and contested within a drug consumption room in Germany. Drawing on empirical data generated during a long-term participatory ethnography conducted in Frankfurt, our analysis attends to the 'invisible labors' of care, alongside the more visible practices by which care is enacted and contested. We unsettle depictions of care as innate and unproblematic components of service delivery in consumption rooms by interrogating care's 'fraught politics'. While mapping relations of care woven through the consumption room, we ask, what modes of care are constrained, subjugated, erased, or neglected within these spaces? We also investigate how diverse modalities of care intersect in the consumption room, what experiences of caring are produced amidst these intersections, for whom, and to what effect. Our analysis aims to make the practices, logics, and techniques that constitute care in the consumption room amenable to critical reflection. In so doing, we contribute to recent discussions of the ethics of care, and they ways it might sustain novel modes of social, affective and material care in drug consumption rooms.

ISSUE ADDRESSED Men's health and lifestyle magazines are a popular medium through which hegemonic ideals of masculinity are displayed, influencing the way men behave and think about health (Crawshaw, 2007, Soc Sci Med, 65, 1606; Stibbe, 2004, Men Masc, 7, 31). METHODS This study conducted a critical discourse analysis of Australia's most popular men's health and lifestyle magazine, Men's Health, in order to understand how health is presented to men. Six issues were examined, from April 2016 to September 2016. RESULTS Three themes supporting hegemonic masculine discourses were revealed: a forged physique, (hetero)sexual prowess and career dominance. A fourth theme, the new man, was also identified revealing a shift in attitudes towards nutrition and style. CONCLUSIONS Despite this shift in the representation of masculinity, hegemonic ideals remain dominant in the construction of Australian masculinity in this popular men's health and lifestyle magazine. SO WHAT?: This study highlights the utility of Men's Health magazine in promoting health and brings into question whether the current representation of masculinity works towards improving or decreasing the health of Australian men.

ISSUE ADDRESSED:A child's preference for active or sedentary play is a key proximal indicator of a child's physical activity behaviour. There is a need to understand children's physical activity preferences in order to make physical play more enjoyable to them, and this may encourage participation and a more positive relationship with physical activity. To date, little research has incorporated the perspectives of young children on this topic. This study specifically examines (a) what activities preschool children prefer; and (b) what children consider to be barriers and facilitators to participating in their preferred activity.METHODS:The authors employed visual methodologies to explore the activity preferences of 29 preschool children. Children were asked to draw their preferred activities and answer a series of open and closed questions about their drawing and what they think are the barriers and facilitators to participating in this activity.RESULTS:Participants expressed a desire to play unstructured activities with friends or family, to engage in imaginative, challenging play, as well as the opportunity to have control over the activity they engage in. Children reported that rules at home and at preschool, the availability of toys, friends and family and having access to a natural environment served as both barriers and facilitators to participating in their favourite activity.CONCLUSIONS:Listening to children's voices about their play preferences and the barriers and facilitators to engaging in these activities provides important insight into children's play behaviour and the promotion of active play in early childhood. Participants' desire for more natural features within their play environment and for challenging, unstructured and imaginative play may be considered as facilitators of their engagement in physical activity. SO WHAT?: The current findings suggest the incorporation of unstructured playtime within natural environments could support young children's participation in and increased enjoyment of physical activity.

Objective:As children become increasingly exposed to health information and education, it is important to understand how these messages affect the way children speak about health and health behaviours. Children are social agents and co-constructors of their social worlds. Exploring how pre-school children speak about health and health-promoting behaviours can help explain what children make of health messages and may help facilitate communication between children, parents and educators. Methods:Participants included 163 pre-school children aged 3–5 years attending childcare centres in South-East Queensland, Australia. Semi-structured interviews were used to explore how pre-school children speak about health and health behaviours. Data were analysed using thematic analysis. Results:Participant responses were structured as two categories. The first category was Meaning of Healthy. This category comprised four themes of eat your food (n = 74 of 145, 51%), participating in activities (n = 36, 24%), growing big and strong (n = 20, 13%) and not being sick (n = 15, 10%). The second category, How to be Healthy, comprised five themes including eat healthy food (n = 86 of 150, 57%), reduce risk (n = 31, 20%), treat illness (n = 13, 8%), be well behaved (n = 12, 8%) and do exercise (n = 8, 5%). Conclusion:Findings highlighted the centrality of food in how children speak about health. In comparison to the discussion of food and the importance of eating healthy food, there was limited mention of physical activity by participants as a way to be healthy. The theme reduce risk emerged from participant responses and relates to the practice of safety behaviours to prevent injury and illness. Future research needs to determine whether the emphasis children place on risk minimisation is shaping how young children speak about health and how this interaction plays out in their health behaviour.

Background: Population health concerns related to physical inactivity and obesity appear in policy documents, government campaigns and popular media across western societies. Children and young people have been targeted for physical activity promotion and schools have been positioned as sites for intervention. In particular, Physical Education and school sport (PESS) has been framed as a key part of the solution. While some interventionist programmes in schools have reported positive outcomes, they have also been criticised for stigmatising fatness, contributing to a culture of surveillance and fuelling body image anxieties. Despite ongoing work to ameliorate these critical issues by addressing physical activity promotion discourses, curricula and teaching practices many of the same challenges persist. In seeking alternative explanations (and solutions) this paper shifts attention to exploring the role of pupils and their peers.Purpose: While the critical literature on health and physical education has been illuminating, few studies explore the role of pupils and their peers. Further research is necessary to understand how school peers contribute to pupils' engagement with PESS. This paper, therefore, draws on Bourdieu's notion of physical capital and seeks to understand how pupils' physical activity is influenced by lived-body experiences in school spaces.The study: Data were produced from a 6-month bricolage-based study with pupils (N=29, aged 13-14) across four diverse school settings in England. Multiple qualitative methods were deployed to enhance methodological rigour with what is often a challenging age group for research. Data were interpreted and theorised using the concept of physical capital.Findings: Pupils themselves play a significant part in establishing the physical body as a symbol of power and status in school settings. Participants understood the health risks of being both underweight and obese, but they regarded obesity as being more problematic because of the immediate social risks of standing out as the bigger one'. Following this rationale, participants sought to accumulate physical capital through engaging in exercise as a purposeful calorie-burning activity intended to avoid the pity, abnormality and derision which is expected to be directed towards overweight pupils. Furthermore, during PESS in clear view of peers, distinctions between pupils' physical capital could be made by recognising differences in sporting skill. In this context, physical capital mediated engagement in PESS in various ways.Conclusion: This study has revealed that peers play a significant part in constructing the lived-body experiences of young people. In order to address the criticisms raised about some school-based health promotion interventions, it is crucial to attend to pupils' relationships with peers as well as addressing policies, curricula and teaching practices. Being sensitive to peer relationships and their understanding of health may help teachers and health promoters decide how to manage the spaces where PESS takes place.

Health inequalities continue to exist in advanced capitalist economies and so-called lifestyle behaviours (e.g. smoking, alcohol consumption, diet and physical (in)activity) play a role in their persistence. Interventionist responses to health inequalities are often posed in terms of either individual agency or social structure - the former being criticised for its shaming/responsibilising effects and the latter for inadequately conceptualising behavioural differences within socio-economic groups. In this paper, we attempt to reconcile these two positions by drawing on Bourdieu's concept of habitus, arguing that health enhancing behaviours are better understood as practices constrained and enabled within social class contexts. As many interventionist health policies target young people in schools, we take the example of physical education and youth sport to illustrate how young people's dispositions towards health practices are part of an emerging class habitus. We draw on data from a sociological study of young people's physical activity and health in which twenty-nine participants (aged 13-14) from four socio-economically diverse school settings took part. The data presented here are selected from 60 focus group transcripts, ethnographic fieldnotes from 6 months of school visits and visual data from participants. Our data indicate that class differences exist in both the kinds of activities practiced by pupils and ways in which they are practiced. We argue that class-based differences are, at least partially, matters of embodied inclinations and dispositions that are already evident at the age of 13/14. Consequently, we demonstrate how school-focused health promotion through physical education and youth sport may contribute to health inequalities as a result of being more or less accessible and appealing to pupils with a different classed-habitus within different educational fields. This paper questions the on-going interventionist policies that position schools as sites for health promotion without adequately accounting for the influence of class cultures.

BACKGROUND:Harm reduction policy and praxis has long struggled to accommodate the pleasures of alcohol and other drug use. Whilst scholars have consistently highlighted this struggle, how pleasure might come to practically inform the design and delivery of harm reduction policies and programs remains less clear. The present paper seeks to move beyond conceptual critiques of harm reduction's 'pleasure oversight' to more focused empirical analysis of how flows of pleasure emerge, circulate and, importantly, may be reoriented in the course of harm reduction practice.METHODS:We ground our analysis in the context of detailed ethnographic research in a drug consumption room in Frankfurt, Germany. Drawing on recent strands of post-humanist thought, the paper deploys the concept of the 'consumption event' to uncover the manner in which these facilities mediate the practice and embodied experience of drug use and incite or limit bodily potentials for intoxication and pleasure.RESULTS:Through the analysis, we mapped a diversity of pleasures as they emerged and circulated through events of consumption at the consumption room. Beyond the pleasurable intensities of intoxication's kick, these pleasures were expressed in a range of novel capacities, practices and drug using bodies. In each instance, pleasure could not be reduced to a simple, linear product of drug use. Rather, it arose for our participants through distinctive social and affective transformations enabled through events of consumption at the consumption room and the generative force of actors and associations of which these events were composed.CONCLUSION:Our research suggests that the drug consumption room serves as a conduit through which its clients can potentially enact more pleasurable, productive and positive relations to both themselves and their drug use. Acknowledging the centrality of pleasure to client engagement with these facilities, the paper concludes by drawing out the implications of these findings for the design and delivery of consumption room services.

The objective of this study was to compare the life satisfaction (LS) of Chinese-immigrant children in the United States (US) with their counterparts in America and China by using the Students’ Life Satisfaction Scale (SLSS). The mean scores of SLSS were examined and compared among three groups. Multivariate linear regression analysis was conducted to identify the differences of LS among comparison groups after adjusting for other potential risk factors. Out of 161 children who completed the surveys, 47 (29%) were Chinese-immigrant children, 81 (50%) were native Chinese children, and 33 (20%) were non-immigrant US children. The results showed that Chinese- immigrant children had higher overall LS than native Chinese children (4.39 ± 0.83 vs 3.79 ± 0.81; p = 0.0001), but lower overall LS than non-immigrant children in the US (4.39 ± 0.83 vs 4.81 ± 0.69; p = 0.0207). Systematic investigation on larger populations will be necessary to identify the potential contributing factors.

High-performance sports provide athletes with a variety of learning experiences. Because athletes invest significant time and energy in training and competition over relatively long periods of time...

Background and purpose: The aim of this study was to describe the learning culture for elite athletes who resided at the Australian Institute of Sport (AIS) from the perspective of the athletes themselves. As a government entity, the AIS is highly regulated by policies and strategies concerning allocation of funding, facilities, services, and resources. There is a substantial body of research examining government interest in elite sport and, in particular, national and state sporting institutes. These meso-level interactions within the AIS context no doubt have an impact on athlete learning. Learning in this context is political and economic as well as social. Thus, the cultural theory of learning is an important tool in considering the political agenda as an integral part of the learning process within the context of the AIS. Data collection and analysis: Participants for this study were purposefully selected from a larger project involving AIS scholarship holding athletes who were residents at the AIS. The final sample of six female athletes from four different sports participated in a single semi-structured interview aimed at gathering a holistic perspective of the current life experiences of the athletes. Thematic analysis involved the three steps of (1) initial coding of text in relation to the research questions, (2) the development of descriptive themes, and (3) the generation of analytical themes. The theoretical lens of the cultural theory of learning shaped the third step of the analysis. As such, the context within which practice took place including the language, social space and hierarchies, and symbolic message systems were foregrounded. Findings: The successful habitus in this field is one which was described by the athletes as organised with a plan, busy, and with multiple interests. Enhanced athletic performance and motivation to train were tied to being able to have time away from sport to relax and do other things. Being in residence at the AIS produced a commodity-driven orientation and encouraged athletes to diversify in order to increase performance, to gain further funding, to maintain their positions at the AIS which afforded the optimum balance for performance, forming a cycle of the interaction between habitus and field. Conclusion: What this investigation offers is an insight into how a set of meso- and macro-level structures around finance and performance are experienced by a sample of national sport institute residential athletes and may demonstrate conditions related to athlete satisfaction. For this group of athletes at least, ‘living sport’ was not conducive to maintaining elite performance and their place at the AIS. These findings are of relevance to coaches of young high-performance athletes and those involved in policy-making and athlete learning in sports institutes.