OBJECTIVE:To explore stakeholder perspectives on current adult cochlear implant services and potential integration of remote assessment tools. DESIGN AND STUDY SAMPLE:Semi-structured focus groups were conducted with four stakeholder groups: adult cochlear implant users with (n = 5) and without (n = 5) experience using a remote assessment tool, implant audiologists (n = 8), and implant clinic administrative staff (n = 4). Participants were asked what they valued most in CI aftercare and how remote care could be integrated to meet their needs. Transcripts underwent inductive qualitative analysis. RESULTS:Stakeholder perspectives coalesced around four themes: bias towards the status quo (connection to current practices, resistance to change); opportunities for change (willingness to incorporate improvements for quality and accessible aftercare); complexity as a barrier (grappling with diverse and complex considerations for implementation); influence from external networks (support and information from outside the direct patient-clinic relationship). All groups acknowledged the benefits of current services and remote care, while attitudes about implementation and accessibility differed between groups. CONCLUSIONS:This study juxtaposes stakeholder preferences to both embrace and restrict uptake of remote care in CI services. The potential for remote care to address shortfalls in existing service delivery will remain unfulfilled unless organisational and financial aspects of implementation are resolved.

INTRODUCTION:Food retail outlets represent a setting where a healthy diet can be promoted. Community public health practitioners need user-friendly tools to collect real-time data, engage with local food retailers, and customise health-enabling initiatives in supermarkets. We aimed to examine the distribution and variation of Store Scout App (SS-App) scores to demonstrate the influence of health-enabling changes within the participant supermarkets. METHODS:Data were collected from 10 supermarkets (5 implementation, 5 control) using the SS-App. The SS-App is a decision-support tool that evaluates health-promoting store practices and provides real-time feedback to retailers. Data were collected through a series of dichotomous (yes/no) questions related to the App's 4Ps of marketing: Promotion, Price, Product, and Placement. The Reach for the Stars programme included promotional and informational materials based on the health star rating of healthier products. Two-way analysis of variance (ANOVA) was used to test the effects of time group (implementation vs. control) and their interaction on overall mean SS-App scores within the study arm. RESULTS:SS-App scores improved from pre- to post-implementation (p < 0.01). A larger increase in SS-App scores was observed in the implementation group (M = 8.7, SD = 3.7) compared to the control group (M = 1.4, SD = 6.1), (t (8) = -2.28, p < 0.05). CONCLUSIONS:The SS-App was key in implementing the programme by ensuring stores aligned with its goals and objectives, supporting and enhancing retailer participation and sustained engagement.

RATIONALE:This is an update of an existing review. The main clinical intervention for mild to moderate hearing loss is the provision of hearing aids, which amplify speech in addition to environmental sounds. Hearing aids are routinely offered and fitted to those who seek help for hearing difficulties. Since the previous 2017 review, further randomised-controlled trials (RCTs) have been published. This review updates the certainty of the evidence and assesses two additional outcomes: mental health and cognition. OBJECTIVES:To evaluate the benefits and harms of hearing aids in adults with mild to moderate hearing loss. SEARCH METHODS:Cochrane Information Specialists searched CENTRAL, Cochrane ENT registry, MEDLINE, Embase, Web of Science, ClinicalTrials.gov, ICTRP and additional sources for published and unpublished trials. The date of the final search was 2 August 2024. We have also included published existing and ongoing studies up to 18 May 2026. ELIGIBILITY CRITERIA:We included RCTs and cross-over trials that investigated the effect of acoustic hearing aids on adults with mild to moderate hearing loss. We did not include cluster-RCTs. We included studies where the control comparison was passive (waiting list, no intervention) or active (e.g. placebo hearing aids, education programmes, assistive listening devices, auditory training). We excluded studies with interventions delivered in a group setting. OUTCOMES:The critical outcomes were hearing-specific health-related quality of life (participation as the key domain) and the adverse effect, pain. Important outcomes were health-related quality of life, listening ability, mental health (loneliness as the prioritised subdomain; other subdomains were depression, anxiety, and social isolation), cognition (working memory as the prioritised subdomain; other subdomains were memory, immediate attention span, set shifting, inhibition, language, processing speed, visuospatial function, and brief measures of global cognitive performance), and the adverse effect, noise-induced hearing loss. We show only prioritised outcomes in the synthesis of results section below and in the summary of findings. RISK OF BIAS:We used the Cochrane tool for assessing risk of bias (RoB 1), and assigned a judgement about the risk of bias for each included study. SYNTHESIS METHODS:We synthesised results for each outcome using random-effects meta-analyses of the standardised mean differences (SMDs). Where this was not possible, we synthesised results using a narrative approach. We used GRADE to assess the certainty of evidence. INCLUDED STUDIES:We included 16 RCTs involving 2261 participants; we added 11 new studies to this update. The studies were conducted in the USA, Europe, Brazil, Hong Kong, and Australia, and were published between 1987 and 2025. Participants had mild to moderate hearing loss. The average age ranged from 58 to 83 years. Study duration was 4 weeks to 3 years. SYNTHESIS OF RESULTS:All studies except one had high or unclear risk for performance and detection bias because blinding was inadequate or absent. Most studies had low risk for selection, attrition, and reporting bias. For hearing-specific health-related quality of life (participation), there is likely to be a large difference favouring those wearing hearing aids over the control comparison (SMD -1.25, 95% confidence interval (CI) -1.63 to -0.87; 8 studies, 1683 participants; moderate-certainty evidence, downgraded for risk of bias). The evidence for pain is very uncertain. Six studies (1186 participants) monitored adverse effects. Of these, one study reported two instances of pain or discomfort (one participant stopped using hearing aids due to pain while wearing them; one stopped using hearing aids due to ear dryness requiring treatment). Certainty of evidence was very low, downgraded for risk of bias and extreme imprecision. For health-related quality of life, there may be a small difference favouring those wearing hearing aids over the control comparison (SMD -0.27, 95% CI -0.46 to -0.09; 4 studies, 1558 participants; low-certainty evidence, downgraded for risk of bias and indirectness). For listening ability, there is likely to be a large difference favouring those wearing hearing aids over the control comparison (SMD -1.28, 95% CI -2.41 to -0.15; 5 studies, 622 participants; moderate-certainty evidence, downgraded for risk of bias). For loneliness, there may be little to no difference between those wearing hearing aids and the control comparison (SMD -0.12, 95% CI -0.25 to 0.01; 2 studies, 907 participants; low-certainty evidence, downgraded for risk of bias and indirectness). For working memory, the evidence is very uncertain about the effect of hearing aids compared to the control (SMD 0.51, 95% CI -0.21 to 1.23; 3 studies, 910 participants; very low-certainty evidence, downgraded for risk of bias, indirectness and inconsistency). Of the six studies that monitored for adverse effects, none reported noise-induced hearing loss (1186 participants; evidence certainty not graded). AUTHORS' CONCLUSIONS:The available evidence suggests that hearing aids likely improve hearing-specific health-related quality of life and listening ability in adults with mild to moderate hearing loss, with a large beneficial effect. Hearing aids may also improve general health-related quality of life. This evidence is compatible with the widespread provision of hearing aids as first-line clinical management in those who seek help for hearing difficulties. The review did not provide evidence that hearing aids were effective at improving loneliness or working memory, nor that hearing aids resulted in adverse effects. To improve the certainty of evidence and ascertain whether the effects of hearing aids vary according to demographics (e.g. age, sex, degree of hearing loss, socioeconomic environment, race and ethnicity), greater consistency is needed in outcome measures used. Longer-term, placebo-controlled studies may be more sensitive to potential effects on mental health and cognition, but it may not be ethically justifiable to withhold hearing aids long term. FUNDING:The review had no dedicated funding. REGISTRATION:Registration (2015) PROSPERO: CRD42016043834 Protocol (2015) DOI: 10.1002/14651858.CD012023 Original review (2017) DOI: 10.1002/14651858.CD012023.pub2.

OBJECTIVE:Audiology-specific mobile apps enhance hearing healthcare by supporting self-management of ear and hearing conditions and their associated secondary impacts. However, app adoption by hearing care professionals (HCPs) and adults accessing hearing services remains inconsistent. Understanding the perceived barriers and facilitators influencing app use is critical for clinical integration. DESIGN:A cross-sectional survey exploring attitudes towards app use and factors influencing HCP recommendation of apps to adult clients. Survey development was informed by implementation science frameworks, including the Normalisation Process Theory (NPT) and determinants of digital engagement. STUDY SAMPLE:Australian HCPs and adults accessing hearing services (aged 40-70 years). RESULTS:A total of 824 adults accessing hearing services and 191 HCPs participated. Almost all (97.5%) adults accessing hearing services owned a smartphone and 46.3% used mobile health (mHealth) apps. HCPs cited digital literacy, dexterity, and cognition as perceived barriers to app adoption, while adults accessing hearing services were more concerned about privacy, security, and cost. CONCLUSIONS:Improving HCP's awareness of available apps, confidence in assessing client digital literacy, and skills in addressing privacy, security, and cost concerns could support the integration of digital solutions in audiology, ensuring equitable access and benefit for all clients, regardless of age, ability, or socioeconomic status.

BACKGROUND:Hearing, vision and cognitive impairments are common yet frequently underrecognized among older adults. Although these impairments affect quality of life, functional independence and psychological well-being, there are no published data on the prevalence and consequences of these impairments in relation to Australian home care populations. This protocol outlines a cross-sectional investigation into the prevalence of hearing, vision and cognitive impairments and their associations with quality of life, functional ability and psychosocial well-being among older Australians receiving home care services. METHODS:A total of 369 participants aged 65 years and older will be recruited from home care services across Australia. Standardized assessment tools will be used to assess hearing, vision and cognitive function, quality of life, daily living activities, mental health and social participation. Multi-variable regression models will explore the impact of sensory and cognitive impairments on health and well-being outcomes. DISCUSSION:With ageing populations, it is increasingly important to support older people to live independently in their own homes rather than needing to move into residential aged care. This study will facilitate understanding of the prevalence and impact of sensory and cognitive impairments among the older Australian home care population. Findings may inform strategies to support health ageing in place, including service planning, care coordination and workforce training. PATIENT OR PUBLIC CONTRIBUTION:Older adults receiving home care services and individuals with lived experience of sensory and cognitive impairments contributed to the study design. A Patient and Public Involvement advisory group and a stakeholder steering group will guide study implementation.

OBJECTIVE:To propose the application of Keyes's Model of Social Wellbeing to guide hearing care professionals (HCPs) in providing social coaching to address the impact of hearing loss on social wellbeing in older adults. DESIGN:A discussion paper introducing Keyes's Model of Social Wellbeing and its application in enhancing the social wellbeing of older adults with hearing loss. Qualitative insights and evidence from various studies are provided to support the application of the proposed model. Examples of how HCPs can use social coaching to help address the effects of hearing loss on social coherence, integration, acceptance, contribution, and actualisation are provided. STUDY SAMPLE:N/A. RESULTS:Hearing loss significantly impacts all five constructs of Keyes's Model of Social Wellbeing, leading to challenges in social coherence, integration, acceptance, contribution, and actualisation. Effective social coaching by HCPs can mitigate these impacts by providing tailored support, enhancing communication skills, and fostering a sense of belonging and purpose. CONCLUSIONS:Integrating social coaching into audiology practice and policy, guided by Keyes's Model, can improve social wellbeing for older adults with hearing loss. This person-centred approach requires HCPs to understand the social implications of hearing loss and deliver targeted interventions to support their clients' social and emotional needs.

Retail food environments play a pivotal role in influencing dietary behaviors, and therefore have huge potential as settings for promoting good nutrition and preventing obesity. Conducting research in retail settings can be challenging due to the varied motivations of the parties involved and the complex nature of retail environments. To improve the quality and consistency of research in this field, we have identified 16 thematic topics aimed at guiding researchers and public health practitioners on how to conduct healthy food retail research. A summary for each topic, encompassing existing methodologies, best practice examples, and knowledge gaps, was developed based on available literature and the collective experience and expertise of 32 multidisciplinary researchers from a high-income perspective engaged in healthy food retail research in a diverse range of retail settings. A summary checklist describing key considerations at each stage of conducting healthy food retail research was also developed.

Online food delivery platforms are omnipresent in the food environment, influencing dietary behaviours through their appeal, convenience, availability, and marketing tactics. Increasingly major online food delivery platforms are entering formal partnerships with Big Tech companies, raising concerns about the growing corporate influence on food choices and public health. These strategic partnerships are likely to lead to market consolidation, increase the visibility and consumption of unhealthy foods, and reinforce digital food purchasing patterns where convenience outweighs health considerations. Our commentary highlights the need for ongoing scrutiny and regulatory oversight of corporate partnerships across digital food systems to mitigate their potentially harmful implications for population nutrition.

CONTEXT:The price and affordability of food are priorities for public health and health equity; however, Australia lacks a consistent method to evaluate healthy versus unhealthy diets, creating a gap in routine food price reporting. OBJECTIVE:This review aimed to identify and summarize recent methods used to assess and monitor the price and/or affordability of food and beverages in Australia using a health lens. DATA SOURCES:Four academic databases (MEDLINE Complete, Global Health, CINAHL Complete, and Business Source Complete) were searched in English from 2016 to 2022. Relevant gray literature was searched through Google Scholar and government websites. DATA EXTRACTION:Five reviewers screened titles and abstracts, and full-text screening was conducted by 1 reviewer, with eligibility confirmed by a second reviewer. The quality of studies was assessed using the Joanna Briggs Institute "Checklist for Analytical Cross-Sectional Studies." DATA ANALYSIS:Twenty-five eligible studies were identified. Eleven studies used a version of the Healthy Diets Australian Standardized Affordability and Pricing protocol to collect prices for a "healthy" diet modelled on dietary guidelines and an "unhealthy" diet based on a habitual Australian diet. These studies consistently found unhealthy diets to be more expensive than healthy diets. Other identified methods included assessing the price of household diets across healthy baskets (n = 6), store types (n = 5), a planetary health diet (n = 1), packaged foods according to their Health Star Rating (n = 1), a fruit and vegetable basket (n = 1), school canteen foods against a traffic light system (n = 1), and weekly healthy meal plans (n = 1). Healthy diets tended to be less costly than less healthy diets, but both diets were often unaffordable in regional areas, for people on low incomes, and for First Nations peoples. CONCLUSION:Consistent country-wide application of methods for monitoring the price and affordability of foods and diets in Australia is needed-including tailored approaches for priority groups. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration no. CRD42022333531.

BACKGROUND:The opportunity to assess cochlear implant outcomes remotely provides the potential to streamline delivery of care for cochlear implant users. However, the conditions required for its implementation into clinic systems must be fully understood to ensure success and sustainability. The objectives of this study were to (i) use a discrete choice experiment quantify the preferences of cochlear implant users when considering use of Cochlear Remote CheckTM, a remote assessment service, and (ii) explore the perceptions, insights and attitudes of CI users that may influence utilisation of a remote service. DESIGN:A discrete choice experiment was administrated to Australian adult cochlear implant users via an online survey. Participants chose between pairs of hypothetical clinical service options for three different clinical scenarios (acute care, troubleshooting and long-term review). Participants answered a series of questions focusing on how and when remote services should be discussed and offered within their hearing journey. RESULTS:A total of 124 adult cochlear implant users completed the survey. Conditional logit analysis revealed the strongest participant preference was clinician continuity for assessment review, followed by low service costs. They preferred to receive assessment results within one week of completion, but not by videoconference/call in the acute care scenario. Only 12% of participants preferred in-clinic visits for all scenarios. Notably, 100% of participants felt that cochlear implant users should be made aware of remote service opportunities available to them. CONCLUSION:Study participants placed high importance on clinician continuity, but preferences for timing and delivery of results were less pronounced. This information can help to inform customisation of remote services by individual clinics. Costs and payment infrastructure for providing remote care require careful consideration. Whilst there is an appetite for use of Remote CheckTM alongside clinic visits, it is not suitable for, nor preferred by, all cochlear implant users.

Introduction Hearing loss is highly prevalent and impacts many aspects of a person’s life, including communication, social engagement, employment, general health and well-being. Yet, many people do not access hearing healthcare and are unaware of the range of hearing healthcare options available. Barriers to hearing healthcare include poor understanding of hearing loss and its impact; poor knowledge of help-seeking for hearing healthcare options; minimal support to help decide which option is best; and stigma related to hearing loss. These barriers lead to many people not receiving the hearing healthcare they need. Guided by theories of behaviour change and implementation science, HearChoice, an online tailored decision support intervention, has been co-developed to empower adults with hearing difficulties by offering them choice and control over their own hearing healthcare. HearChoice aims to facilitate informed decisions, accessibility and uptake of hearing healthcare, including a wide range of interventions, for adults with hearing difficulties. The objectives of the trial are to evaluate the effectiveness, health economics and feasibility of HearChoice.Methods and analysis This online randomised controlled trial will recruit participants with hearing difficulties across Australia, with an anticipated sample size of 640. Participants will be randomised to either HearChoice (treatment) or an Australia-specific Hearing Option Grid (active control), both delivered online. Outcomes will be assessed at baseline when the interventions will be offered, at 7 days post-intervention (primary endpoint) and at 3 months post-intervention. An email reminder will be sent at 1-month post-intervention. The primary outcome is decisional conflict. Secondary outcomes include measures of readiness and self-efficacy to take action, hearing-related quality of life and empowerment, assessment of the value and impact of HearChoice, work performance and health, and feasibility measures. Primary analysis will compare outcomes between HearChoice and the active control at the primary endpoint.Ethics and dissemination The study was approved by the Curtin University Human Ethics Committee (HRE2023-0024). All participants will provide written informed consent prior to participation. A broad dissemination plan of the study findings includes peer-reviewed publications, scientific conference presentations, articles and presentations for the wider community and public written in lay and accessible language, and social media.Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12624001139561).

BACKGROUND:Hearing loss and tinnitus are pervasive disabilities globally, which significantly impact individuals' quality of life. Integrating Digital Health Interventions (DHIs) with traditional audiological management has proven beneficial for hearing loss and tinnitus management. Although it is established that DHI engagement is important for the real-world effectiveness of DHIs, there is a lack of systematic evidence aiming to understand engagement with DHIs in audiology. PURPOSE:This systematic review identified factors associated with hearing healthcare DHI engagement to inform future DHI development and research in audiology. METHODS:Adhering to Synthesis without Meta-Analysis guidelines, we conducted a mixed-methods systematic review using a convergent integrated approach. A comprehensive search across seven databases until December 16, 2023, identified 62 studies meeting inclusion criteria. Data extraction involved modifying the Joanna Briggs Institute (JBI) extraction form and deductive coding using the Perski et al. (2017) framework to identify factors related to engagement. RESULTS:The review revealed a diverse range of factors associated with DHI engagement in the audiology literature. CONCLUSION:Analysis within the Perski et al. (2017) framework highlighted the importance of user-related constructs, such as enhancing DHI accessibility, empowering users, and aligning DHIs with user needs and lifestyles in facilitating engagement. Due to the limited number of studies focusing on engagement as the primary outcome, we based our inferences on secondary outcomes and discussions from the available literature. While this review consolidates existing knowledge on engagement, it underscored the imperative for more in-depth investigations into engagement with hearing healthcare DHIs.

OBJECTIVE:To explore perceived barriers and enablers to help-seeking and informed decision-making in hearing care in order to inform an intervention targeted at maximising uptake of hearing care (HearChoice). DESIGN:Data were collected using semi-structured interviews and analysed qualitatively using a hybrid deductive and inductive thematic analysis approach based on the COM-B model of behaviour change. STUDY SAMPLE:Sixteen adults with hearing difficulty took part (9 male, 7 female, age range 27 - 90), nine of whom had sought professional help for hearing difficulties and seven of whom had not. RESULTS:Participants described a range of interacting barriers and enablers to help-seeking and decision-making for hearing care that relate to psychological capability (e.g. knowledge; skills), environmental and social opportunity (e.g. supportive social circle and health care providers) and automatic and reflective motivation (e.g. shame; trust; beliefs about effectiveness of hearing aids). CONCLUSION:Interventions to facilitate help-seeking and informed decision-making about care options for adults with hearing difficulties are likely to be most effective if factors that increase psychological capability, environmental and social opportunity, and automatic and reflective motivation are maximised. The framework developed from this study will inform the development of HearChoice and future research on help-seeking and decision-making.

Large food and beverage corporations employ strategies to advance profits, often with adverse implications for public health. However, the practices of online food delivery companies have not been systematically examined from a public health perspective. This study aimed to explore the nature and extent of the corporate activities of Uber Eats Australia that may present a risk to public health. Using a theoretically guided qualitative design, we analysed Uber Eats’ strategies from 2016 to 2024 through a Commercial Determinants of Health framework. A total of 374 documents were identified through searches of academic and business databases, as well as Uber Eats’ social media and websites, and these were coded according and narratively synthesised. Uber Eats Australia commonly targeted food marketing toward families, often using celebrity endorsements and sponsoring major sporting events. It employs exclusivity agreements and accepts financial losses to expand market share, while promoting self-regulation by positioning itself as a partner of small businesses and the Australian economy. Gig-economy drivers, however, are frequently paid below minimum wage and experience poor working conditions. Additionally, the platform facilitates access to and promotion of unhealthy food options, contributing to poorer dietary health at a population level. Regulatory actions should be considered for the online food delivery sector to ensure public health is prioritised over corporate gain.

Healthy diets are unaffordable for billions of people worldwide, with food prices rising in high-, middle- and low-income nations in recent times. Despite widespread attention to this issue, recent actions taken to inform policy prioritisation and government responses to high food inflation have not been comprehensively synthesised. Our review summarises (i) innovative efforts to monitor national food and healthy diet price, ii) new policy responses adopted by governments to address food inflation and (iii) future research directions to inform new evidence. Evidence synthesis. Global. None. We describe how timely food and beverage pricing data can provide transparency in the food industry and identify key areas for intervention. However, government policies that improve food affordability are often short-lived and lack sustained commitment. Achieving meaningful impact will require long-term, cross-sectoral actions that are led by governments to support food security, healthy diets and resilient sustainable food systems. This will necessitate a better understanding of how the political economy enables (or hinders) policy implementation, including through coherent problem framing, mitigating conflicts of interest in policymaking, working together as coalitions and developing and utilising evidence on the food security and related impacts of food pricing and affordability policies. Diverse actors must be better equipped with robust data platforms and actionable policy solutions that improve the affordability of healthy and sustainable diets, including by lowering food prices and addressing the broader socio-political determinants of food insecurity.

BACKGROUND:Co-design has emerged as a preferred collaborative approach among public health practitioners and researchers to increase the potential for effective design, implementation, and dissemination of innovations in practice. However, there is a lack of consistency in its application and reporting, which limits co-design theory building and best practice. This systematic review aimed to examine the peer-reviewed literature reporting on the use of co-design as a process in public health, synthesizing co-design definitions, processes, models or frameworks, and participant involvement. METHODS:Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines, a systematic review was conducted. MEDLINE Complete, Global Health, and CINAHL databases were searched in April 2024. RESULTS:Fifty-five articles on co-design in public health published between 2016 and 2024 were included, noting a publication surge in 2023. Most studies were from Oceania, especially Australia. While 44% lacked a co-design definition, 56% highlighted its collaborative, inclusive nature. Over half (64%) used specific frameworks with a 4-5 stage process. Participant roles varied from informants to co-designers, with many studies not developing prototypes for testing. CONCLUSIONS:A more transparent and systematic application of co-design principles, guided by clearer frameworks and reporting standards, could improve the consistency and effectiveness of co-design in public health.

In the mid-90s, we embarked on establishing the domain of Workplace Deviance. Though we were fortunate to meet our intended goals and have the impact we had hoped for, we have often thought about what we might have done differently. In this essay, we outline some of the things we wish we knew then that we know now. As we will describe, we perhaps should have chosen a different construct name, taken a theoretical rather than data driven approach to our typology, and developed a reflective rather than formative scale. We hope this essay based on our hindsight may be of value to future scholars seeking to establish new constructs in our field.