Participant characteristics and reasons for non-consent to health information linkage for research: experiences from the ATHENA COVID-19 study.

BACKGROUND: The linkage of primary care, hospital and other health registry data is a global goal, and a consent-based approach is often used. Understanding the attitudes of why participants take part is important, yet little is known about reasons for non-participation. The ATHENA COVID-19 feasibility study investigated: 1) health outcomes of people diagnosed with COVID-19 in Queensland, Australia through primary care health data linkage using consent, and 2) created a cohort of patients willing to be re-contacted in future to participate in clinical trials. This report describes the characteristics of participants declining to participate and reasons for non-consent. METHODS: Patients diagnosed with COVID-19 from January 1st, 2020, to December 31st, 2020, were invited to consent to having their primary healthcare data extracted from their GP into a Queensland Health database and linked to other data sets for ethically approved research. Patients were also asked to consent to future recontact for participation in clinical trials. Outcome measures were proportions of patients consenting to data extraction, permission to recontact, and reason for consent decline. RESULTS: Nine hundred and ninety-five participants were approached and 842(85%) reached a consent decision. 581(69%), 615(73%) and 629(75%) consented to data extraction, recontact, or both, respectively. Mean (range) age of consenters and non-consenters were 50.6(22-77) and 46.1(22-77) years, respectively. Adjusting for age, gender and remoteness, older participants were more likely to consent than younger (aOR 1.02, 95%CI 1.01 to 1.03). The least socio-economically disadvantaged were more likely to consent than the most disadvantaged (aOR 2.20, 95% 1.33 to 3.64). There was no difference in consent proportions regarding gender or living in more remote regions. The main reasons for non-consent were 'not interested in research' (37%), 'concerns about privacy' (15%), 'not registered with a GP' (8%) and 'too busy/no time' (7%). 'No reason' was given in 20%. CONCLUSION: Younger participants and the more socio-economically deprived are more likely to non-consent to primary care data linkage. Lack of patient interest in research, time required to participate and privacy concerns, were the most common reasons cited for non-consent. Future health care data linkage studies addressing these issues may prove helpful.

What makes an action plan "100% me"? Think aloud interviews about CVD prevention tools for varying health literacy needs.

ISSUE ADDRESSED: Health behaviour change can be difficult to maintain. Action plans can address this issue, however, there has been little qualitative research to understand how to optimise action plan interventions. This study explored how people engage with a specific type of action plan intervention, the "volitional help sheet," in a cardiovascular disease (CVD) prevention context. METHODS: Twenty adults in the target age for CVD risk assessment (45 to 74 years) with varying health literacy participated in interviews and created an action plan to change their behaviour. Transcripts were analysed using framework analysis. RESULTS: Participants described how engagement with plans was related to how personally relevant the target behaviour and the options within the plan were. Also important was participants visualising themselves enacting the plan when deciding which option to choose. Amongst participants who already engaged in a target behaviour, some did not perceive the plan was useful; others perceived the plan as a helpful prompt or a formalisation of existing plans. For some, the barriers to behaviour change were out of the scope of an action plan, highlighting the need for alternative supports. CONCLUSION: This study provides qualitative insights into unanticipated ways that people with varying health literacy use action plans, providing new guidance for future developers. SO WHAT?: Not all action plans are created equal. Careful selection of behavioural targets and plan options and encouraging users to imagine the plan may enhance user engagement. Alternative behaviour change strategies should be available if key barriers cannot be addressed by the plan.

Integrating consumer perspectives into a large-scale health literacy audit of health information materials: learnings and next steps.

BACKGROUND: Health information is less effective when it does not meet the health literacy needs of its consumers. For health organisations, assessing the appropriateness of their existing health information resources is a key step to addressing this issue. This study describes novel methods for a consumer-centred large-scale health literacy audit of existing resources and reflects on opportunities to further refine the method. METHODS: This audit focused on resources developed by NPS MedicineWise, an Australian not-for-profit that promotes safe and informed use of medicines. The audit comprised 4 stages, with consumers engaged at each stage: 1) Select a sample of resources for assessment; 2) Assess the sample using subjective (Patient Education Materials Assessment Tool) and objective (Sydney Health Literacy Lab Health Literacy Editor) assessment tools; 3) Review audit findings through workshops and identify priority areas for future work; 4) Reflect and gather feedback on the audit process via interviews. RESULTS: Of 147 resources, consumers selected 49 for detailed assessment that covered a range of health topics, health literacy skills, and formats, and which had varied web usage. Overall, 42 resources (85.7%) were assessed as easy to understand, but only 26 (53.1%) as easy to act on. A typical text was written at a grade 12 reading level and used the passive voice 6 times. About one in five words in a typical text were considered complex (19%). Workshops identified three key areas for action: make resources easier to understand and act on; consider the readers' context, needs, and skills; and improve inclusiveness and representation. Interviews with workshop attendees highlighted that audit methods could be further improved by setting clear expectations about the project rationale, objectives, and consumer roles; providing consumers with a simpler subjective health literacy assessment tool, and addressing issues related to diverse representation. CONCLUSIONS: This audit yielded valuable consumer-centred priorities for improving organisational health literacy with regards to updating a large existing database of health information resources. We also identified important opportunities to further refine the process. Study findings provide valuable practical insights that can inform organisational health actions for the upcoming Australian National Health Literacy Strategy.

COVID-19 messages targeting young people on social media: content analysis of Australian health authority posts.

Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) shared by Australian health departments. Posts targeting young people with COVID-19 information were extracted from all eight Australian State and Territory health department Facebook, Instagram and TikTok accounts over 1 month of the Delta outbreak (September 2021) and analysed thematically. In total, 238 posts targeting young people were identified from 1059 COVID-19 posts extracted. All eight health departments used Facebook, five used Instagram and only one used TikTok. The majority of posts implicitly targeted young people; only 14.7% explicitly mentioned age or 'young people'. All posts included accompanying visuals; 77% were still images like photos or illustrations whilst 23% were moving images like videos and GIFs. Communication techniques included calls to action (63% of posts), responsive communication (32% of posts) and positive emotional appeal (31% of posts). Social marketing techniques catering to young people were used to varying extents despite receiving higher levels of engagement; 45% featured emojis whilst only 16% used humour, 14% featured celebrities and 6% were memes. Priority groups like ethnic/cultural groups and chronic health/disability communities were rarely targeted in this communication. The findings indicate a lack of health communication on social media directed towards young people, highlighting an opportunity for increased use of platforms like TikTok and trends popular with young people online.

Biological age calculators to motivate lifestyle change: Environmental scan of online tools and evaluation of behaviour change techniques.

OBJECTIVE: "Biological age" calculators are widely used as a way of communicating health risk. This study evaluated the behaviour change techniques (BCTs) within such tools, underlying algorithm differences and suitability for people with varying health literacy. METHODS: Two authors entered terms into Google (eg, biological/heart age) and recorded the first 50 results. A standard patient profile was entered into eligible biological age calculators. Evaluation was based on Michie et al's BCT taxonomy and a readability calculator. RESULTS: From 4000 search results, 20 calculators were identified: 11 for cardiovascular age, 7 for general biological age and 2 for fitness age. The calculators gave variable results for the same 65-year-old profile: biological age ranged from younger to older (57-87 years), while heart age was always older (69-85+ years). Only 11/20 (55%) provided a reference explaining the underlying algorithm. The average reading level was Grade 10 (range 8.7-12.4; SD 1.44). The most common BCTs were salience of consequences, information about health consequences and credible source. CONCLUSIONS: Biological age tools have highly variable results, BCTs and readability. PRACTICE IMPLICATIONS: Developers are advised to use validated models, explain the result at the average Grade 8 reading level, and incorporate a clear call to action using evidence-based behaviour change techniques.

The impact of health literacy on psychosocial and behavioural outcomes among people at low risk of cardiovascular disease.

This study aimed to explore the impact of health literacy on psychosocial and behavioural outcomes for people who were not at high risk of cardiovascular disease receiving a hypothetical blood pressure reading of 135/85 mmHg. We performed a secondary analysis of data from a national sample of Australians aged 40 to 50 years (n = 1318) recruited online. Health literacy was measured using the validated Newest Vital Sign (inadequate: 0-3; adequate: 4-6). Analysed outcomes included: willingness to increase exercise and accept medication; perceived severity; positive and negative affect; illness perceptions and impacts on life and motivation. Participants with inadequate levels of health literacy perceived a blood pressure reading of 135/85 mmHg to be less serious compared to individuals with adequate health literacy (Mean Difference [MD]:0.21; 95%CI 0.03-0.39; p = .024; d = 0.13), and reported less motivation to eat well (MD:0.44; 95%CI 0.31-0.58; p < .001; d = 0.38) and exercise (MD:0.43; 95%CI 0.31-0.58; p < .001; d = 0.36). However, they were more willing to accept medication (MD:0.20; 95%CI 0.07-0.34; p = .004; d = 0.17). Participants with inadequate health literacy also perceived the condition to have fewer negative impacts on aspects of life and work than individuals with adequate health literacy, but reported greater negative emotion and more negative illness perceptions (all p < .001). Tailored communication and behaviour change support may be needed when communicating blood pressure information to people with lower health literacy and not at high risk of cardiovascular disease given the differential impacts on medication (increased willingness) and healthy exercise and diet behaviours (decreased willingness) observed in this study.

Clinician views and experiences of non-invasive prenatal genetic screening tests in Australia.

BACKGROUND: Non-invasive prenatal screening (NIPS) is being increasingly used by expectant parents. Much provision of this test in Australia is occurring in clinical settings where specialised genetic counselling is unavailable, such as general practice. Potential psychosocial consequences from this kind of prenatal genetic screening remain largely unexplored. AIMS: To explore clinicians' experiences with NIPS for aneuploidy, their perspectives of the benefits and harms of NIPS, clinicians' information needs, and their perceptions of the needs of expectant parents. MATERIALS AND METHODS: Qualitative, semi-structured interviews with 17 health professionals (clinical geneticists, obstetricians, genetic counsellors and general practitioners) who request and counsel for NIPS in Australian hospital and private practice settings, conducted between June 2019 and February 2020. RESULTS: Five themes were identified relating to clinicians' perceptions and experiences of NIPS in their practice: perceived benefits of NIPS, perceived harms of NIPS (with two subthemes: clinical harms and psychosocial harms), financial and equity-related concerns, counselling as a protective buffer against perceived harms, and clinicians' unmet education needs. While clinicians view NIPS as a useful and high-quality screening test, especially for detection of common trisomies, many participants had concerns about how NIPS has been implemented in practice, particularly the quality (and often absence) of pre-/post-test counselling and the routinisation of testing for sex chromosome aneuploidies, microdeletion and microduplication syndromes. CONCLUSION: These findings support the need for targeted clinician training around NIPS, and for a shared decision-making approach to support expectant parents' autonomous decisions about NIPS.

The role of Primary Health Networks in cardiovascular disease prevention: A qualitative interview study.

BACKGROUND: Since the inception of PHNs in Australia, their role in implementing chronic disease prevention activities in general practice has been unclear. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention. METHODS: Content analysis of PHN Needs Assessments was conducted to inform interview questions. Twenty-nine semi-structured interviews were conducted with 32 PHN staff, between June and December 2020, in varied roles across 18 PHNs in all Australian states and territories. Transcribed audio recordings were thematically coded, using the Framework Analysis method to ensure rigour. RESULTS: We identified three main themes: (a) Informal prevention: All respondents agreed the role of PHNs in prevention was indirect and, for the most part, outside the formal remit of PHN Key Performance Indicators (KPIs.) Prevention activities were conducted in partnership with external stakeholders, professional development and quality improvement programs, and PHN-funded data extraction and analysis software for general practice. (b) Constrained by financial incentives: Most interviewees felt the role of PHNs in prevention was contingent on the financial drivers provided by the Commonwealth government, such as Medicare funding and national quality improvement programs. (c) Shaped through competing priorities: The role of PHNs in prevention is a function of competing priorities. There was strong agreement amongst participants that the myriad competing priorities from government and local needs assessments impeded prevention activities. CONCLUSIONS: PHNs are well-positioned to foster prevention activities in general practice. However, we found that PHNs role in prevention activities was informal, constrained by financial incentives and shaped through competing priorities. Prevention can be improved through a more explicit prevention focus at the Commonwealth government level. To optimise the role of PHNs, therefore, requires prioritising prevention, aligning it with KPIs and supporting stakeholders like general practice.

Positive outcomes associated with the COVID-19 pandemic in Australia.

ISSUE ADDRESSED: To investigate whether Australians have experienced any positive effects during the COVID-19 pandemic. METHODS: National online longitudinal survey. As part of a June 2020 survey, participants (n = 1370) were asked 'In your life, have you experienced any positive effects from the COVID-19 pandemic' (yes/no) and also completed the World Health Organisation-Five well-being index. Differences were explored by demographic variables. Free-text responses were thematically coded. RESULTS: Nine hundred sixty participants (70%) reported experiencing at least one positive effect during the COVID-19 pandemic. Living with others (P = .045) and employment situation (P < .001) at baseline (April) were associated with experiencing positive effects. Individuals working for pay from home were more likely to experience positive effects compared to those who were not working for pay (aOR = 0.45, 95% CI: 0.32, 0.63, P < .001) or who were working for pay outside the home (aOR = 0.40, 95% CI: 0.28, 0.58, P < .001). 54.2% of participants reported a sufficient level of well-being, 23.2% low well-being and a further 22.6% very low well-being. Of those experiencing positive effects, 945/960 (98%) provided an explanation. The three most common themes were 'Family time' (33%), 'Work flexibility' (29%) and 'Calmer life' (19%). CONCLUSIONS: A large proportion of participants reported positive effects resulting from changes to daily life due to the COVID-19 pandemic in Australia. SO WHAT: The needs of people living alone, and of those having to work outside the home or who are unemployed, should be considered by health policymakers and employers in future pandemic preparedness efforts.

'Every medicine is part poison': a qualitative inquiry into the perceptions and experiences of choosing contraceptive methods of migrant Chinese women living in Australia.

BACKGROUND: In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migrant women's contraceptive method choice and practices will help cater to their decision-making needs in a culturally sensitive and responsive way. METHODS: A qualitative study design underpinned by critical realism approach was used to explore Chinese migrant women's perceptions and experiences of choosing contraceptive methods. Semi-structured interviews were conducted with 22 women who self-identified as being ethnically Chinese and had been living in Australia for no more than 10 years. The interview guide was adapted from the Ottawa Decision Support Framework. Majority of the interviews were conducted in Mandarin Chinese. Transcribed data was analysed using thematic analysis method. RESULTS: Four major themes were identified, including: 'every medicine is part poison: hormonal contraceptives cause harm to the body'; 'intrauterine device, a device used in the past for married women'; 'it takes two (or one) to decide, depending on the relationship dynamics and contraception preferences'; and 'it is not necessary to seek medical advice in choosing contraceptive methods'. CONCLUSIONS: Our findings suggest that Chinese migrant women's perceptions and experiences of choosing contraceptive methods are influenced by complex personal, cultural, societal and inter-relational factors. Chinese migrant women were cautious of using hormonal methods due to fears of side-effects, including reduced or absent menstrual bleeding. Women were also reluctant to consider intrauterine devices as options due to associating them with past experiences of other women and themselves and also fears of potential complications. There was a reluctant attitude towards seeking medical advice regarding contraception due to beliefs that needing to use contraception is not an illness requiring treatment. Such findings are likely to be useful in increasing healthcare professionals' and policy makers' understanding of Chinese migrant women's contraceptive method preferences, beliefs and behaviours. They also help to develop culturally and linguistically sensitive strategies, which goes beyond the provision of contraceptive counselling, in assisting Chinese migrant women's decision-making needs.

The role of older patients' goals in GP decision-making about medicines: a qualitative study.

BACKGROUND: To optimise medication use in older people, it is recommended that clinicians evaluate evidence on potential benefits and harms of medicines in light of the patients' overall health, values and goals. This suggests general practitioners (GPs) should attempt to facilitate patient involvement in decision-making. In practice this is often challenging. In this qualitative study, we explored GPs' perspectives on the importance of discussing patients' goals and preferences, and the role patient preferences play in medicines management and prioritisation. METHODS: Semi-structured interviews were conducted with GPs from Australia (n = 32). Participants were purposively sampled to recruit GPs with variation in experience level and geographic location. Transcribed audio-recordings of interviews were coded using Framework Analysis. RESULTS: The results showed that most GPs recognised some value in understanding older patients' goals and preferences regarding their medicines. Most reported some discussions of goals and preferences with patients, but often this was initiated by the patient. Practical barriers were reported such as limited time during busy consultations to discuss issues beyond acute problems. GPs differed on the following main themes: 1) definition and perception of patients' goals, 2) relationship with the patient, 3) approach to medicines management and prioritisation. We observed that GPs preferred one of three different practice patterns in their approach to patients' goals in medicines decisions: 1) goals and preferences considered lower priority - 'Directive'; 2) goals seen as central - 'Goal-oriented'; 3) goals and preferences considered but not explicitly elicited - 'Tacit'. CONCLUSIONS: This study explores how GPs differ in their approach to eliciting patients' goals and preferences, and how these differences are operationalised in the context of older adults taking multiple medicines. Although there are challenges in providing care that aligns with patients' goals and preferences, this study shows how complex decisions are made between GPs and their older patients in clinical practice. This work may inform future research that investigates how GPs can best incorporate the priorities of older people in decision-making around medicines. Developing practical support strategies may assist clinicians to involve patients in discussions about their medicines.

COVID-19 Misinformation Trends in Australia: Prospective Longitudinal National Survey.

BACKGROUND: Misinformation about COVID-19 is common and has been spreading rapidly across the globe through social media platforms and other information systems. Understanding what the public knows about COVID-19 and identifying beliefs based on misinformation can help shape effective public health communications to ensure efforts to reduce viral transmission are not undermined. OBJECTIVE: This study aimed to investigate the prevalence and factors associated with COVID-19 misinformation in Australia and their changes over time. METHODS: This prospective, longitudinal national survey was completed by adults (18 years and above) across April (n=4362), May (n=1882), and June (n=1369) 2020. RESULTS: Stronger agreement with misinformation was associated with younger age, male gender, lower education level, and language other than English spoken at home (P<.01 for all). After controlling for these variables, misinformation beliefs were significantly associated (P<.001) with lower levels of digital health literacy, perceived threat of COVID-19, confidence in government, and trust in scientific institutions. Analyses of specific government-identified misinformation revealed 3 clusters: prevention (associated with male gender and younger age), causation (associated with lower education level and greater social disadvantage), and cure (associated with younger age). Lower institutional trust and greater rejection of official government accounts were associated with stronger agreement with COVID-19 misinformation. CONCLUSIONS: The findings of this study highlight important gaps in communication effectiveness, which must be addressed to ensure effective COVID-19 prevention.

Effects of health literacy, screening, and participant choice on action plans for reducing unhealthy snacking in Australia: A randomised controlled trial.

BACKGROUND: Low health literacy is associated with poorer health outcomes. A key strategy to address health literacy is a universal precautions approach, which recommends using health-literate design for all health interventions, not just those targeting people with low health literacy. This approach has advantages: Health literacy assessment and tailoring are not required. However, action plans may be more effective when tailored by health literacy. This study evaluated the impact of health literacy and action plan type on unhealthy snacking for people who have high BMI or type 2 diabetes (Aim 1) and the most effective method of action plan allocation (Aim 2). METHODS AND FINDINGS: We performed a 2-stage randomised controlled trial in Australia between 14 February and 6 June 2019. In total, 1,769 participants (mean age: 49.8 years [SD = 11.7]; 56.1% female [n = 992]; mean BMI: 32.9 kg/m2 [SD = 8.7]; 29.6% self-reported type 2 diabetes [n = 523]) were randomised to 1 of 3 allocation methods (random, health literacy screening, or participant selection) and 1 of 2 action plans to reduce unhealthy snacking (standard versus literacy-sensitive). Regression analysis evaluated the impact of health literacy (Newest Vital Sign [NVS]), allocation method, and action plan on reduction in self-reported serves of unhealthy snacks (primary outcome) at 4-week follow-up. Secondary outcomes were perceived extent of unhealthy snacking, difficulty using the plans, habit strength, and action control. Analyses controlled for age, level of education, language spoken at home, diabetes status, baseline habit strength, and baseline self-reported serves of unhealthy snacks. Average NVS score was 3.6 out of 6 (SD = 2.0). Participants reported consuming 25.0 serves of snacks on average per week at baseline (SD = 28.0). Regarding Aim 1, 398 participants in the random allocation arm completed follow-up (67.7%). On average, people scoring 1 SD below the mean for health literacy consumed 10.0 fewer serves per week using the literacy-sensitive action plan compared to the standard action plan (95% CI: 0.05 to 19.5; p = 0.039), whereas those scoring 1 SD above the mean consumed 3.0 fewer serves using the standard action plan compared to the literacy-sensitive action plan (95% CI: -6.3 to 12.2; p = 0.529), although this difference did not reach statistical significance. In addition, we observed a non-significant action plan × health literacy (NVS) interaction (b = -3.25; 95% CI: -6.55 to 0.05; p = 0.054). Regarding Aim 2, 1,177 participants across the 3 allocation method arms completed follow-up (66.5%). There was no effect of allocation method on reduction of unhealthy snacking, including no effect of health literacy screening compared to participant selection (b = 1.79; 95% CI: -0.16 to 3.73; p = 0.067). Key limitations include low-moderate retention, use of a single-occasion self-reported primary outcome, and reporting of a number of extreme, yet plausible, snacking scores, which rendered interpretation more challenging. Adverse events were not assessed. CONCLUSIONS: In our study we observed nominal improvements in effectiveness of action plans tailored to health literacy; however, these improvements did not reach statistical significance, and the costs associated with such strategies compared with universal precautions need further investigation. This study highlights the importance of considering differential effects of health literacy on intervention effectiveness. TRIAL REGISTRATION: Australia and New Zealand Clinical Trial Registry ACTRN12618001409268.

Experiences of a National Web-Based Heart Age Calculator for Cardiovascular Disease Prevention: User Characteristics, Heart Age Results, and Behavior Change Survey.

BACKGROUND: Heart age calculators are used worldwide to engage the public in cardiovascular disease (CVD) prevention. Experimental studies with small samples have found mixed effects of these tools, and previous reports of population samples that used web-based heart age tools have not evaluated psychological and behavioral outcomes. OBJECTIVE: This study aims to report on national users of the Australian heart age calculator and the follow-up of a sample of users. METHODS: The heart age calculator was launched in 2019 by the National Heart Foundation of Australia. Heart age results were calculated for all users and recorded for those who signed up for a heart age report and an email follow-up over 10 weeks, after which a survey was conducted. CVD risk factors, heart age results, and psychological and behavioral questions were analyzed using descriptive statistics and chi-square tests. Open responses were thematically coded. RESULTS: There were 361,044 anonymous users over 5 months, of which 30,279 signed up to receive a heart age report and 1303 completed the survey. There were more women (19,840/30,279, 65.52%), with an average age of 55.67 (SD 11.43) years, and most users knew blood pressure levels (20,279/30,279, 66.97%) but not cholesterol levels (12,267/30,279, 40.51%). The average heart age result was 4.61 (SD 4.71) years older than the current age, including (23,840/30,279, 78.73%) with an older heart age. For the survey, most users recalled their heart age category (892/1303, 68.46%), and many reported lifestyle improvements (diet 821/1303, 63.01% and physical activity 809/1303, 62.09%). People with an older heart age result were more likely to report a doctor visit (538/1055, 51.00%). Participants indicated strong emotional responses to heart age, both positive and negative. CONCLUSIONS: Most Australian users received an older heart age as per international and UK heart age tools. Heart age reports with follow-up over 10 weeks prompted strong emotional responses, high recall rates, and self-reported lifestyle changes and clinical checks for more than half of the survey respondents. These findings are based on a more engaged user sample than previous research, who were more likely to know blood pressure and cholesterol values. Further research is needed to determine which aspects are most effective in initiating and maintaining lifestyle changes. The results confirm high public interest in heart age tools, but additional support is needed to help users understand the results and take appropriate action.

People's Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study.

BACKGROUND: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people's experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. OBJECTIVE: This study aimed to compare participants' perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. METHODS: A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. RESULTS: Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was "just as good as" or "better than" their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals' willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants' telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. CONCLUSIONS: Based on our sample's responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic.

Healthcare providers' perceptions of the challenges and opportunities to engage Chinese migrant women in contraceptive counselling: a qualitative interview study.

Background In Australia, there are many culturally and linguistically diverse communities and Chinese migrants make up one of the largest. Yet, little is known about healthcare providers' (HCPs) unique experiences in providing contraceptive care for Chinese migrant women. There is minimal research into the HCPs' perceptions of challenges or opportunities in engaging Chinese migrant women in informed and shared decision-making processes during contraceptive counselling. The aim of this study is to explore HCPs' experiences of providing contraceptive care for Chinese migrant women, their perceptions of women's care needs when choosing contraceptive methods, as well as their own needs in supporting women's decision-making. METHODS: Semi-structured interviews were conducted with 20 HCPs in Sydney, Australia who had substantial experience in providing contraceptive services to Chinese women who were recent migrants. Transcribed audio-recorded data were analysed using thematic analysis. RESULTS: Four main themes were identified, including: 'Are you using contraception?': the case for being proactive and opportunistic; 'Getting the message across': barriers to communication; 'Hormones are unnatural?': women favouring non-hormonal methods; and 'Word of mouth': social influence on contraceptive method choice. CONCLUSIONS: In order to facilitate informed choice and shared decision-making with Chinese migrant women during contraceptive counselling, broader health system and community-level strategies are needed. Such strategies could include improving HCPs' cultural competency in assessing and communicating women's contraceptive needs; providing professional interpreting services and translated materials; and improving women's health literacy, including their contraceptive knowledge and health system awareness.

Availability and readability of patient education materials for deprescribing: An environmental scan.

AIMS: To identify and evaluate content and readability of freely available online deprescribing patient education materials (PEMs). METHODS: Systematic review of PEMs using MEDLINE, Embase, CINAHL, PsycINFO and The Cochrane Library of Systematic Reviews from inception to 25 September 2017 to identify PEMs. Additionally, deprescribing researchers and health professionals were surveyed to identify additional materials. Known repositories of materials were searched followed by a systematic Google search (22-28 January 2018). Materials were evaluated using an approach informed by the Patient Education Material Assessment Tool and the International Patient Decision Aids Standards Inventory. Readability of text-based materials was assessed using the US-based Gunning-Fog Index and Flesch-Kincaid Grade level. RESULTS: Forty-eight PEMs were identified. PEMs addressing deprescribing of medications for symptom control (81%) were most common. Preventative medications were rarely addressed and material (39%) focused on older people. Only 37% of PEMs provided information about both potential benefits (e.g. reducing risk of side effects) and harms (e.g. withdrawal symptoms, increased risk of disease) of deprescribing, while 40% focussed on benefits only. Readability indices indicated an average minimum reading level of Grade 12. Option Grids and Decision Aids (mean reading level below Grade 10) were most suitable for people with average literacy levels. CONCLUSIONS: Over 1/3 of deprescribing PEMs present potential benefits and harms of deprescribing indicating most of the freely available materials are not balanced. Most PEMs are pitched above average reading levels making them inaccessible for low health literacy populations.

Should heart age calculators be used alongside absolute cardiovascular disease risk assessment?

BACKGROUND: National estimates of 'heart age' by government health organisations in the US, UK and China show most people have an older heart age than current age. While most heart age calculators are promoted as a communication tool for lifestyle change, they may also be used to justify medication when clinical guidelines advocate their use alongside absolute risk assessment. However, only those at high absolute risk of a heart attack or stroke are likely to benefit from medication, and it is not always clear how heart age relates to absolute risk. This article aims to: 1) explain how heart age calculation methods relate to absolute risk guidelines; 2) summarise research investigating whether heart age improves risk communication; and 3) discuss implications for the use of medication and shared decision making in clinical practice. MAIN BODY: There is a large and growing number of heart age models and online calculators, but the clinical meaning of an older heart age result is highly variable. An older heart age result may indicate low, moderate or high absolute risk of a heart attack or stroke in the next 5-10 years, and the same individual may receive a younger or older heart age result depending on which calculator is used. Heart age may help doctors convey the need to change lifestyle, but it cannot help patients make an informed choice about medication to reduce CVD risk. CONCLUSION: Interactive heart age tools may be helpful as a communication tool to initiate lifestyle change to reduce risk factors. However, absolute risk should be used instead of heart age to enable informed decision making about medication, to avoid unnecessary treatment of low risk people. Evidence-based decision aids that improve patient understanding of absolute risk should be considered as alternatives to heart age calculators for lifestyle and medication decisions.

Psychosocial Impact of a Positive Gene Result for Asymptomatic Relatives at Risk of Hypertrophic Cardiomyopathy.

Families with a history of hypertrophic cardiomyopathy (HCM) may be offered genetic testing in addition to clinical surveillance. Asymptomatic family members who are gene positive (silent gene carriers) represent a new group of "patients" who may not develop HCM, with little evidence available to assist clinical management. This study explored experiences of HCM genetic testing to identify potential benefits and harms. Thirty-two individuals previously offered genetic testing for HCM were recruited. Semi-structured interviews were conducted face-to-face or by phone, and transcribed audio-recordings were coded using framework analysis. Key themes were as follows: (1) helping the next generation, (2) misunderstanding risk, (3) discrepancy between actual/perceived impact. Participants described multiple psychological (shock, worry, uncertainty) and behavioural (career, sport, insurance, family planning) consequences, depending on perceived risk. Most considered only the benefits of genetic testing for children or grandchildren, but there were some cases of significant adverse impact. The interpretation of the HCM genetic test result is variable for silent gene carriers and can lead to psychological and behavioural changes. The impact of a positive gene result may be mitigated by increased clarity of the clinical consequences and efforts to ensure informed decision-making, highlighting even further the important role of cardiac genetic counselling.

Clinical Validity, Understandability, and Actionability of Online Cardiovascular Disease Risk Calculators: Systematic Review.

BACKGROUND: Online health information is particularly important for cardiovascular disease (CVD) prevention, where lifestyle changes are recommended until risk becomes high enough to warrant pharmacological intervention. Online information is abundant, but the quality is often poor and many people do not have adequate health literacy to access, understand, and use it effectively. OBJECTIVE: This project aimed to review and evaluate the suitability of online CVD risk calculators for use by low health literate consumers in terms of clinical validity, understandability, and actionability. METHODS: This systematic review of public websites from August to November 2016 used evaluation of clinical validity based on a high-risk patient profile and assessment of understandability and actionability using Patient Education Material Evaluation Tool for Print Materials. RESULTS: A total of 67 unique webpages and 73 unique CVD risk calculators were identified. The same high-risk patient profile produced widely variable CVD risk estimates, ranging from as little as 3% to as high as a 43% risk of a CVD event over the next 10 years. One-quarter (25%) of risk calculators did not specify what model these estimates were based on. The most common clinical model was Framingham (44%), and most calculators (77%) provided a 10-year CVD risk estimate. The calculators scored moderately on understandability (mean score 64%) and poorly on actionability (mean score 19%). The absolute percentage risk was stated in most (but not all) calculators (79%), and only 18% included graphical formats consistent with recommended risk communication guidelines. CONCLUSIONS: There is a plethora of online CVD risk calculators available, but they are not readily understandable and their actionability is poor. Entering the same clinical information produces widely varying results with little explanation. Developers need to address actionability as well as clinical validity and understandability to improve usefulness to consumers with low health literacy.