Exploring motivations for engagement with the Healthy Lunch Box campaign on social media.

Many health organisations seek social media engagement through their online health promotion campaigns, but there is little understanding of what engagement means in relation to the uptake of health messages. To understand the relevance of social media engagement, we need to look at the reasons why people engage with health content via social media. This exploratory study examined people's motivations for engaging with health content through a case study of the Healthy Lunch Box campaign. Data was collected via online focus groups (n = 7), with participants being a convenience sample of people who had seen or engaged with the Healthy Lunch Box resources (n = 24). The discussions covered reasons for engaging with the Healthy Lunch Box campaign, and more broadly with health content on social media in general. The data was analysed using a reflexive approach to thematic analysis, with themes developed inductively. The study found that some of the reasons for engagement aligned with the paradigm of social media engagement being an intermediary step in the process towards health behaviour change. However, people also described other reasons, such as alignment with their personal values, consideration of their online presentation, or as a way of curating the content they wanted to be shown on social media. These results demonstrate that people's decision to engage with health-related social media content involves more than consideration about the usefulness of the content, suggesting the need for a deeper examination of the assumptions made about the value of social media engagement in health campaign evaluations.

Hope and sadness: Balancing emotions in tobacco control mass media campaigns aimed at smokers.

ISSUE ADDRESSED: Australia has smoking prevalence of less than 15% among adults, but there are concerns that the rates of decline have stabilised. Sustained mass media campaigns are central to decreasing prevalence, and the emotions evoked by campaigns contribute to their impact. This study investigates the association between potential exposure to campaigns that evoke different emotions on quitting salience (thinking about quitting), quitting intentions and quitting attempts. METHODS: Data on quitting outcomes were obtained from weekly cross-sectional telephone surveys with adult smokers and recent quitters between 2013 and 2018. Campaign activity data were collated, and population-level potential campaign exposure was measured by time and dose. RESULTS: Using multivariate analyses, a positive association between potential exposure to 'hope' campaigns and thinking about quitting and intending to quit was noted, but no association was seen with quit attempts. Potential exposure to 'sadness' evoking campaigns was positively associated with quitting salience and negatively associated with quit attempts, whereas those potentially exposed to campaigns evoking multiple negative emotions (fear, guilt and sadness) were approximately 30% more likely to make a quit attempt. CONCLUSIONS: This study suggests a relationship between the emotional content of campaigns, quitting behaviours. Campaign planners should consider campaigns that evoke negative emotions for population-wide efforts to bring about quitting activity alongside hopeful campaigns that promote quitting salience and quitting intentions. The emotional content of campaigns provides an additional consideration for campaigns targeting smokers and influencing quitting activity. SO WHAT?: This study demonstrates the importance of balancing the emotional content of campaigns to ensure that campaign advertising is given the greatest chance to achieve its objectives. Utilising campaigns that evoke negative emotions appear to be needed to encourage quitting attempts but maintaining hopeful campaigns to promote thinking about quitting and intending to quit is also an important component of the mix of tobacco control campaigns.

Evaluation of 'Shisha No Thanks' - a co-design social marketing campaign on the harms of waterpipe smoking.

BACKGROUND: Waterpipe (shisha) is becoming increasingly popular worldwide, particularly among young people; and in some countries, it is one of the few forms of tobacco use that is increasing. While there is a growing body of evidence of the harms of waterpipe smoke, there is a scarcity of research of interventions to address this form of tobacco consumption. METHODS: The Shisha No Thanks project was a co-design social marketing campaign that aimed to raise awareness of the harms of waterpipe smoking among young people from an Arabic speaking background in Sydney, Australia. The campaign distributed material through social media and community events. We evaluated the project through an SMS community panel using a longitudinal study design. The cohort were sent questions before and after the project asking about their awareness of messages of harms, attitudes, intention to reduce waterpipe smoking, and awareness of support services. Data was analysed as matched pre- post- data. RESULTS: The evaluation recruited 133 people to the panel. There was a significantly greater proportion of people who reported seeing, hearing or reading something about the harms of waterpipe smoking after the campaign (67.5%) compared with before (45.0%) (p=0.003). Post-campaign, there were higher proportions of people who strongly agreed that waterpipe smoking causes damage, and that it contains cancer-causing substances, but these increases were not statistically significant. There was low awareness of waterpipe cessation services at baseline and post campaign (22.5%). CONCLUSIONS: The Shisha No Thanks project increased awareness of messages about the harms of waterpipe smoking. Although this is a small study, the longitudinal evaluation findings have international relevance and make a useful contribution to the understanding of the impact such interventions can have in addressing one of the few forms of tobacco use that is growing in both developed and developing countries.

Acceptability of financial incentives for maintenance of weight loss in mid-older adults: a mixed methods study.

BACKGROUND: Health insurers worldwide implement financial incentive schemes to encourage health-related behaviours, including to facilitate weight loss. The maintenance of weight loss is a public health challenge, and as non-communicable diseases become more prevalent with increasing age, mid-older adults could benefit from programs which motivate weight loss maintenance. However, little is understood about their perceptions of using financial incentives to maintain weight loss. METHODS: We used mixed methods to explore the attitudes and views of participants who had completed an Australian weight loss and lifestyle modification program offered to overweight and obese health insurance members with weight-related chronic diseases, about the acceptability and usefulness of different types of financial incentives to support weight loss maintenance. An online survey was completed by 130 respondents (mean age = 64 years); and a further 28 participants (mean age = 65 years) attended six focus groups. RESULTS: Both independent samples of participants supported a formalised maintenance program. Online survey respondents reported that non-cash (85.2%) and cash (77%) incentives would be potentially motivating; but only 40.5% reported that deposit contracts would motivate weight loss maintenance. Results of in-depth discussions found overall low support for any type of financial incentive, but particularly deposit contracts and lotteries. Some participants expressed that improved health was of more value than a monetary incentive and that they felt personally responsible for their own health, which was at odds with the idea of financial incentives. Others suggested ongoing program and peer support as potentially useful for weight loss maintenance. CONCLUSIONS: If financial incentives are considered for mid-older Australian adults in the health insurance setting, program planners will need to balance the discordance between participant beliefs about the individual responsibility for health and their desire for external supports to motivate and sustain weight loss maintenance.

A review of the impact of physical activity mass media campaigns on low compared to high socioeconomic groups.

Physical inactivity is a major contributor to non-communicable disease and people of low socioeconomic status (SES) are more likely to be insufficiently active. Physical activity mass media campaigns aim to increase physical activity participation, but little is known about their impact on low SES groups. We reviewed the published literature from 1990 to June 2016 to identify reports of physical activity mass media campaigns. We documented evaluation/study design, target population, campaign outcomes assessed, SES measures used and analysed the results of the SES comparisons. A total of 23 papers were reviewed, reporting on 17 physical activity campaigns and 12 campaigns compared SES differences for 85 outcomes: 45 comparisons showed no difference between lowest and highest SES groups, 20 showed a better outcome for the lowest SES group and 20 showed a worse outcome. Some campaigns found inconsistent results, but seven found only equal and/or better results for low SES groups. Post-campaign physical activity behaviour most commonly showed no SES differences, but no other patterns were seen. Our review found that physical activity mass media campaigns have mostly equitable or better impacts for low SES groups, but to reduce inequalities these campaigns need to be maximally effective for low SES populations.

Cardiac Patients' Experiences and Perceptions of Social Media: Mixed-Methods Study.

BACKGROUND: Traditional in-person cardiac rehabilitation has substantial benefits for cardiac patients, which are offset by poor attendance. The rapid increase in social media use in older adults provides an opportunity to reach patients who are eligible for cardiac rehabilitation but unable to attend traditional face-to-face groups. However, there is a paucity of research on cardiac patients' experiences and perspectives on using social media to support their health. OBJECTIVE: The aim of this study was to describe cardiac rehabilitation patients' experiences in using social media in general and their perspective on using social media, particularly Facebook, to support their cardiac health and secondary prevention efforts. METHODS: A mixed-methods study was undertaken among cardiac rehabilitation patients in both urban and rural areas. First, this study included a survey (n=284) on social media use and capability. Second, six focus group interviews were conducted with current Facebook users (n=18) to elucidate Facebook experience and perspectives. RESULTS: Social media use was low (28.0%, 79/282) but more common in participants who were under 70 years of age, employed, and had completed high school. Social media users accessed Web-based information on general health issues (65%, 51/79), medications (56%, 44/79), and heart health (43%, 34/79). Participants were motivated to invest time in using Facebook for "keeping in touch" with family and friends and to be informed by expert cardiac health professionals and fellow cardiac participants if given the opportunity. It appeared that participants who had a higher level of Facebook capability (understanding of features and the consequences of their use and efficiency in use) spent more time on Facebook and reported higher levels of "liking," commenting, or sharing posts. Furthermore, higher Facebook capability appeared to increase a participants' willingness to participate in a cardiac Facebook support group. More capable users were more receptive to the use of Facebook for cardiac rehabilitation and more likely to express interest in providing peer support. Recommended features for a cardiac rehabilitation Facebook group included a closed group, expert cardiac professional involvement, provision of cardiac health information, and ensuring trustworthiness of the group. CONCLUSIONS: Cardiac health professionals have an opportunity to capitalize on cardiac patients' motivations and social media, mostly Facebook, as well as the capability for supporting cardiac rehabilitation and secondary prevention. Participants' favored purposeful time spent on Facebook and their cardiac health provides such a purpose for a Facebook intervention. The study results will inform the development of a Facebook intervention for secondary prevention of cardiovascular disease.

Knowledge of the signs and symptoms and risk factors of lung cancer in Australia: mixed methods study.

BACKGROUND: Lung cancer is the leading cause of cancer death in Australia. There is potential that health promotion about the risks and warning signs of lung cancer could be used to reduce delays in symptom presentation when symptoms are first detected. This study investigated knowledge, attitudes and beliefs which might impact help-seeking behaviour and could provide insight into possible public health interventions in New South Wales (NSW). METHODS: A convergent mixed method study design was used wherein data from 16 qualitative focus groups of residents (40+ years), purposefully recruited and stratified by smoking status, age and geography (metropolitan/regional), were compared with a CATI administered population-wide telephone survey (n = 1,000) using the Cancer Research UK cancer awareness measure (LungCAM). Qualitative findings were analysed thematically using NVIVO. Logistic regression analysis was used to investigate predictors of symptom knowledge in STATA. Findings were integrated using triangulation techniques. RESULTS: Across focus groups, haemoptysis was the only symptom creating a sense of medical urgency. Life experiences evoked a 'wait and see' attitude to any health deterioration. Perceived risk was low amongst those at risk with current smokers preferring to deny their risk while former smokers were generally unaware of any ongoing risk. The quantitative sample consisted of females (62 %), 40-65 years (53 %), low SES (53 %), former (46 %) and current smokers (14 %). In quantitative findings, haemoptysis and dyspnoea were the most recognised symptoms across the sample population. Age (<65 years), sex (female) and high socio-economic status contributed to a higher recognition of symptoms. Smoking was recognised as a cause of lung cancer, yet ever-smokers were less likely to recognise the risk of lung cancer due to second-hand smoke (OR 0.7 95 % CI 0.5-0.9). CONCLUSION: While there was some recognition of risk factors and symptoms indicative of lung cancer, there was disparity across the sample population. The qualitative findings also suggest that knowledge may not lead to earlier presentation; a lack of urgency about symptoms considered trivial, and smoking-related barriers such as stigma may also contribute to time delays in presentation. Public health interventions may be required to increase awareness of risk and emphasise the importance of seeking medical attention for ongoing symptoms.

Impact of the Swap It, Don't Stop It Australian National Mass Media Campaign on Promoting Small Changes to Lifestyle Behaviors.

Mass media campaigns aimed at influencing lifestyle risk factors are one way that governments are attempting to address chronic disease risk. In Australia, a national campaign aimed at encouraging Australians to make changes in lifestyle-related behaviors was implemented from 2008 to 2011. The first phase, Measure Up (2008-2009), focused on why lifestyle changes are needed by increasing awareness of the link between waist circumference and chronic disease risk. The second phase, Swap It, Don't Stop It (2011), emphasized how adults can change their behaviors. Cross-sectional telephone surveys (after the campaign) were undertaken in July and November 2011 to evaluate the Swap It, Don't Stop It campaign and included measures of campaign awareness and lifestyle-related behavior change. Survey participants (N = 5,097) were similar across the two survey periods. Prompted campaign awareness was 62% (16% for unprompted awareness); females, younger respondents (18-44 years), those in paid employment, and those who spoke English at home were more likely to report prompted/unprompted campaign awareness. Moreover, 16% of survey respondents reported any swapping behavior in the previous 6 months, with the majority (14%) reporting only one swap; younger respondents and those in paid employment were significantly more likely to report having implemented a swapping behavior. The campaign achieved modest population awareness but demonstrated limited effect in terms of nudging behaviors. This evaluation indicates that encouraging swapping behaviors as a prelude to lifestyle change may not result from a mass media campaign alone; a comprehensive multicomponent population approach may be required.

Finding the keys to successful adult-targeted advertisements on obesity prevention: an experimental audience testing study.

BACKGROUND: Mass media communications are an important component of comprehensive interventions to address population levels of overweight and obesity, yet we have little understanding of the effective characteristics of specific advertisements (ads) on this topic. This study aimed to quantitatively test audience reactions to existing adult-focused public health television ads addressing overweight and obesity to determine which ads have the highest levels of message acceptance, argument strength, personalised perceived effectiveness and negative emotional impact. METHODS: 1116 Australian adults aged 21-55 years recruited from a national online panel participated in this web-based study. Quotas were applied to achieve even numbers of males and females, those aged 21-29 years and 30-55 years, and those with a healthy weight (BMI = 18.5-24.9) and overweight/obesity (BMI = 25+). Participants were randomly assigned to view and rate four of eight ads that varied in terms of message content (health consequences, supportive/encouraging or social norms/acceptability) and execution style (graphic, simulation/animation, positive or negative testimonial, or depicted scene). RESULTS: Toxic fat (a graphic, health consequences ad) was the top performing ad on all four outcome measures and was significantly more likely than the other ads tested to promote strong responses in terms of message acceptance, argument strength and negative emotional impact. Measure up (a negative testimonial, health consequences ad) performed comparably on personalised perceived effectiveness. Most ads produced stronger perceptions of personalised perceived effectiveness among participants with overweight/obesity compared to participants with healthy weight. Some ads were more likely to promote strong negative emotions among participants with overweight/obesity. CONCLUSIONS: Findings provide preliminary evidence of the most promising content and executional styles of ads that could be pursued as part of obesity prevention campaigns. Ads emphasising the negative health consequences of excess weight appear to elicit stronger cognitive and emotional responses from adults with overweight/obesity. However, careful pre-testing of these types of ads is needed prior to their inclusion in actual campaigns to ensure they do not have unintended negative impacts such as increased stigmatisation of vulnerable individuals and increased levels of body dissatisfaction and/or eating-disordered behaviour among at-risk population sub-groups.

Translational research: are community-based child obesity treatment programs scalable?

BACKGROUND: Community-based obesity treatment programs have become an important response to address child obesity; however the majority of these programs are small, efficacy trials, few are translated into real-world situations (i.e., dissemination trials). Here we report the short-term impact of a scaled-up, community-based obesity treatment program on children's weight and weight-related behaviours disseminated under real world conditions. METHODS: Children age 6-15 years with a body mass index (BMI) ≥ 85th percentile with no co-morbidities, and their parents/carers participated in a twice weekly, 10-week after-school child obesity treatment program between 2009 and 2012. Outcome information included measures of weight and weight-related behaviours. Analyses were adjusted for clustering and socio-demographic variables. RESULTS: Overall, 2,812 children participated (54.2% girls; M(age) 10.1 (2.0) years; M(attaendance) 12.9 (5.9) sessions). Beneficial changes among all children included BMI (-0.65 kg/m(2)), BMI-z-score (-0.11), waist circumference (-1.8 cm), and WtHtr (-0.02); self-esteem (+2.7 units), physical activity (+1.2 days/week), screen time (-4.8 h/week), and unhealthy foods index (-2.4 units) (all p < 0.001). Children who completed ≥ 75% of the program were more likely to have beneficial changes in BMI, self-esteem and diet (sugar sweetened beverages, lollies/chocolate, hot chips and takeaways) compared with children completing <75% of the program. CONCLUSIONS: This is one of the few studies to report outcomes of a government-funded, program at scale in a real-world setting, and shows that investment in a community-based child obesity treatment program holds potential to produce short-term changes in weight and weight-related behaviours. The findings support government investment in this health priority area, and demonstrate that community-based models of child obesity treatment are a promising adjunctive intervention to health service provision at all levels of care.

Role of general practice in the utilisation of the NSW Get Healthy Information and Coaching Service.

A lifestyle-modification telephone-based service is delivered in New South Wales (NSW; the Get Healthy Information and Coaching Service (GHS)) as an important obesity-prevention, population-wide program. The present study examined referrals from general practitioners (GP) versus self-referral to the GHS in terms of risk profile and effectiveness of outcomes. The study used a pre-post test design to assess changes in outcomes within the setting of a telephone-based lifestyle-support service available to NSW adults (18+ years) who self-referred or were referred by their health practitioner and/or GP, and registered for the GHS between February 2009 and August 2013 (n = 22 183). The GHS has two service components: (1) the provision of an information kit (one off contact) on healthy eating, being physically active and achieving and/or maintaining a healthy weight; and (2) a 6-month coaching program that includes 10 telephone calls aimed at achieving and maintaining lifestyle-related goals. Sociodemographic characteristics, referral source and self-reported anthropometric (height, waist and waist circumference (WC)) and behavioural risk factor (physical activity and nutrition-related behaviours) data were collected at baseline and at 6 months. Analysis revealed that GPs effectively recruited hard-to-reach subtargets, as well as adults who are obese and have an increased WC risk. Participants in the GHS coaching program, irrespective of GHS referral source, reported a mean weight loss of -3.8 kg, a decrease in WC of -5.0 cm and increases in both fruit and vegetable consumption and physical activity. In conclusion, GPs have an important role in GHS uptake (through proactive referral or as an adjunct to practice-based interventions) because they can recruit those most at need and facilitate improvements in their patients' risk factor profiles.

Temporal trends in weight and current weight-related behaviour of Australian Aboriginal school-aged children.

OBJECTIVES: To report 13-year trends in weight status of Australian Aboriginal children, and to describe weight-related behaviour in children in 2010, by Aboriginality. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional population surveys of children aged 5-16 years (n = 18 983) conducted in New South Wales schools in Term 1 of 1997, 2004 and 2010. MAIN OUTCOME MEASURES: For trend analysis: body mass index and waist-to-height ratio (WtHr). Analyses of weight-related behaviour from 2010 survey data included indicators of dietary habits, screen time (ST) and physical activity. RESULTS: Between 1997 and 2010, the relative increase in prevalence of overweight/obesity and WtHr ≥ 0.5 was 22.4% and 113.6%, respectively, among Aboriginal children, and 11.8% and 3.4%, respectively, among non-Aboriginal children. In 2010, Aboriginal children had 1.52 (95% CI, 1.03-2.24) greater odds of having a WtHr ≥ 0.5 than non-Aboriginal children. Compared with non-Aboriginal children, Aboriginal children also had significantly lower odds of eating breakfast daily (adjusted odds ratio [AOR], 0.72; 95% CI, 0.52-0.99) and significantly greater odds of drinking ≥ 1 cup of soft drink daily (AOR, 1.61; 95% CI, 1.13-2.29), having a television in their bedroom (AOR, 2.75; 95% CI, 2.04-3.70), having no ST rules (AOR, 1.34; 95% CI, 1.04-1.73) and exceeding ST recommendations on weekdays (AOR, 1.78; 95% CI, 1.32-2.39). CONCLUSIONS: Overweight/obesity and WtHr have increased more rapidly in Aboriginal than non-Aboriginal children in NSW. Unhealthy weight-related behaviour was frequent among all children, but lack of daily breakfast, excessive ST and soft drink consumption appear particularly problematic among Aboriginal children. Raising awareness with families of the consequences of excessive ST and encouraging strategies to limit ST (such as rethinking placement of televisions in children's bedrooms and implementing ST rules) hold promise.

Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun®.

BACKGROUND: Community-based obesity treatment programs for children that have a large program reach are a priority. To date, most programs have been small efficacy trials whose findings have yet to be up-scaled and translated into real-world settings. This paper reports on the process evaluation of a government-funded, translated obesity treatment program for children in Australia. It describes the characteristics and reach of children participating in the New South Wales (NSW) Ministry of Health Go4Fun® program. METHODS: Delivered across the state of NSW (Australia) by Local Health Districts (LHDs), Go4Fun® is a community-based, multidisciplinary family obesity treatment program adapted from the United Kingdom Mind Exercise Nutrition Do it (MEND) program that targets weight-related behaviours. Children aged 7-13 years with a BMI ≥85th percentile and no co-morbidities were eligible at no cost. Parents/carers self-refer via a toll-free phone number, text messages, online registration or via secondary referrals. LHDs deliver a 16 to 20-session program based on length of school term, holidays and recruitment challenges. Both parent/carer and child attend bi-weekly after school sessions. Parent-reported socio-demographic and measured child weight characteristics are presented using descriptive statistics. Differences between completers (attended at least 75% of sessions) and non-completers were assessed using chi-square tests, independent sample t-tests and adjusted odds ratios. Analyses were adjusted for clustering of programs. RESULTS: Between 2009 and 2012, a total of 2,499 children (54.8% girls; mean age [SD]: 10.2 [1.7 years]) participated in the Go4Fun® program. Children were mainly from low-middle socioeconomic status (76.5%), resided in major cities (63.3%), and 5.7% were Aboriginal. At baseline, 96.5% of children were overweight or obese. Mean BMI-z-score was 2.07 (0.41) and 94.5% had a waist-to-height ratio ≥0.5. More than half (57.9%) completed at least 75% of sessions. Amongst completers (N = 1,446), girls (56.8%; p = 0.02), non-Aboriginal children (95.9%; p < 0.01) and children residing in less socially disadvantaged areas (25.9%; p = 0.02) were significantly more likely to complete the program. CONCLUSIONS: The Go4Fun® program successfully reached the targeted population of overweight/obese children at socioeconomic disadvantage and is a rare example of an up-scaled translational program.

'Translational formative evaluation': critical in up-scaling public health programmes.

The process of generating evidence-based public health interventions is understood to include steps that define the issue, generate and test solutions in controlled settings, replicate and then disseminate more widely. However, to date models have not considered the types and scale of formative evaluation tasks that are needed to up-scale interventions, from efficacy to population-wide dissemination in the real world. In this paper, we propose that an additional stage of 'translational formative evaluation' is necessary for the translation of effectiveness evidence into wide-scale public health practice. We illustrate the utility of translational formative evaluation, through a case study of the Get Healthy Information and Coaching Service(®) (GHS), a population-based telephone service designed to assist adults change lifestyle-related behaviours. The additional translational formative evaluation steps comprised synthesis of efficacy studies, qualitative research with the wider target audience, environmental analysis and stakeholder consultation. They produced precise recommendations to refine GHS design and implementation. Translational formative evaluation is a necessary intermediate step, following efficacy studies and a precursor to population-wide implementation of public health programmes.

Longer term impact of the mass media campaign to promote the Get Healthy Information and Coaching Service®: increasing the saliency of a new public health program.

The Get Healthy Information and Coaching Service® (GHS) was introduced in New South Wales in February 2009. It used mass reach media advertising and direct mail and/or proactive marketing to recruit participants. This article reports on the long-term impact of the campaign on GHS participation from July 2011 to June 2012. A stand-alone population survey collected awareness, knowledge, and behavioral variables before the first advertising phase, (n = 1,544, August-September 2010), during the advertising period (n = 1,500, February-March 2011; n = 1,500, June-July 2011; n = 1,500, February 2012), and after the advertising period (n = 1,500, June-July 2012). GHS usage data (n = 6,095) were collated during July 2011-June 2012. Unprompted and prompted awareness of GHS mass media significantly increased (0% to 8.0%, p < .001; and 14.1% to 43.9%, p < .001, respectively) as well as knowledge and perceived effectiveness of the GHS. Those from the lowest three quintiles of socioeconomic disadvantage and respondents who were overweight or obese were significantly more likely to report prompted campaign awareness. The majority (84.4%) of new GHS calls occurred when television advertising was present. Participants who cited mass media as their referral source were significantly more likely to enroll in the intensive coaching program. Mass media campaigns remain an effective method of promoting a telephone-based statewide lifestyle program.

Effectiveness of Australia's Get Healthy Information and Coaching Service: maintenance of self-reported anthropometric and behavioural changes after program completion.

BACKGROUND: The Get Healthy Information and Coaching Service (GHS) is a population-wide telephone-based program aimed at assisting adults to implement lifestyle improvements. It is a relatively uncommon example of the translation of efficacious trials to up-scaled real-world application. GHS participants who completed the 6-month coaching program made significant initial improvements to their weight, waist circumference, Body Mass Index (BMI), physical activity and nutrition behaviours. This study examines the maintenance of anthropometric and behaviour change improvements 6-months after program completion. METHODS: GHS coaching participants (n=1088) were recruited between February 2009 and June 2011. Participants were eligible if they completed the 6-month coaching program and had available data at 12-month follow-up (n=277). Weight, waist circumference, BMI, fruit and vegetable consumption and physical activity were collected at baseline and 6-months by GHS coaches and 12-months (6-months post program) by independent evaluators. Matched pair t-tests, mixed linear regression and logistic regression analyses were performed to assess maintenance of program effects. RESULTS: Improvements in weight (-2.9 kg, 95% CI: -3.6, -2.1), waist circumference (-5.4 cm, 95% CI: -6.7, -4.1), BMI (-1.1 units, 95% CI: -1.5, -0.8), and fruit (+0.3 serves per day, 95% CI: 0.2, 0.3) and vegetable (+0.5 serves per day 95% CI: 0.3, 0.6) consumption were observed from baseline to 12-months. Apart from vegetable consumption, there were no significant differences between 6-month and 12-month changes from baseline, indicating these risk factor improvements were maintained from the end of the coaching program. There were also improvements in the proportion of participants undertaking recommended levels of physical activity from baseline to 12-months (increase of 5.2%), however the improvements made at end of the coaching program were not maintained at the 6-month follow up. CONCLUSIONS: This study provides preliminary evidence that the GHS has potential to contribute to substantial improvements in the chronic disease risk factor profile of program completers and facilitates sustained maintenance six months after completing the coaching program.

Evaluation framework for translational research: case study of Australia's get healthy information and coaching service(R).

The Get Healthy Information and Coaching Service® (GHS), a free government-funded telephone-delivered information and coaching service was launched in February 2009 by the Australian New South Wales state government. It represents the translation of research evidence applied in the real world (T4 or Phase 4 translation), aimed at addressing the modifiable risk factors associated with the overweight and obesity. In controlled settings, it has been established that telephone-based lifestyle counseling programs are efficacious in reducing anthropometric and behavioral risk factors. This article presents the GHS case study as a population-wide intervention and describes the quasi-experimental evaluation framework used to evaluate both the process (statewide implementation) and impact (effectiveness) of the GHS in a real-world environment. It details the data collection, measures, and statistical analysis required in assessing the process of implementation-reach and recruitment, marketing and promotion, service satisfaction, intervention fidelity, and GHS setting up and operations costs-and in assessing the impact of GHS-increasing physical activity, improving dietary practices, and reducing body weight and waist circumference. The comprehensive evaluation framework designed for the GHS provides a method for building effectiveness evidence of a rare translation of efficacy trial evidence into population-wide practice.

Impact Evaluation of the Get Healthy in Pregnancy Program: Evidence of Effectiveness.

The efficacy of lifestyle interventions for reduced gestational weight gain (GWG) is established, but evidence of their effectiveness is limited. The Get Healthy in Pregnancy (GHiP) program is a telephone health coaching program supporting healthy GWG delivered state-wide in New South Wales, Australia. This evaluation explores the impact of GHiP on behavioural outcomes and GWG, analysing GHiP participant data (n = 3702 for 2018-2019). We conducted McNamar's tests to explore within-individual change for behavioural outcomes and logistic regression to assess associations between demographic characteristics, participant engagement and behavioural and weight outcomes for women who completed the program. Participants who completed ten coaching calls made significant improvements (all p < 0.001) in more health-related behaviours (walking, vigorous physical activity, vegetable consumption, takeaway meals and sweetened drink consumption) than those who completed fewer calls. Among women with valid weight change data (n = 245), 31% gained weight below, 33% gained weight within, and 36% gained weight above GWG guidelines. Pre-pregnancy BMI was the only factor significantly associated with meeting GWG guidelines. Women with pre-pregnancy overweight and obesity had lower odds than those with a healthy weight of having GWG within the guidelines. The majority of these women did not gain weight above the guidelines. A higher proportion of women with pre-pregnancy obesity gained weight below the guidelines (33.8%) than above the guidelines (28.5%). GHiP has the potential to support all pregnant women, including those with pre-pregnancy obesity, to achieve a healthier pregnancy.

Effectiveness of Australia's Get Healthy Information and Coaching Service®: translational research with population wide impact.

OBJECTIVE: With increasing rates of non-communicable disease, there is a need for implementing population-wide, evidence-based interventions for improving behavioural risk factors. Telephone-based interventions provide one option. This study reports on the evaluation of the Australia's Get Healthy Information and Coaching Service®, to improve lifestyle behaviours, amongst a population-wide sample who completed the 6-month coaching programme. METHODS: Using a pre-post design, New South Wales participants who completed telephone-based coaching between February 2009 and December 2011 were included. Outcomes comprised self-reported weight, waist circumference, height, physical activity and dietary behaviours. Matched pair analyses and multivariate modelling were performed to assess behavioural changes. RESULTS: Participants (n=1440) reported statistically significant improvements in weight (-3.9 kg (5.1)); waist circumference (-5.0 cm (6.0)); and Body Mass Index (-1.4 BMI units (1.8)); number of walking and moderate-vigorous physical activity sessions of ≥30 min per week; number of vigorous physical activity sessions of ≥20 min per week and servings of vegetables; fruit; take-away meals and sweetened drinks (all p<0.001). Improvements in weight, waist, moderate physical activity, fruit and vegetable and take-away meals consumption remained significant after adjusting for socio-demographic characteristics. CONCLUSIONS: These results support the effectiveness of replicating an evidence-based intervention in improving population risk factors for chronic disease.

Using mass-media communications to increase population usage of Australia's Get Healthy Information and Coaching Service®.

BACKGROUND: Global obesity prevalence is increasing and population health programs are required to support changes to modifiable lifestyle risk factors. Such interventions benefit from mass-communications to promote their use. The Get Healthy Information and Coaching Service ® (GHS) utilised mass-reach media advertising to recruit participants to an Australian state-wide program. METHODS: A stand alone population survey collected awareness, knowledge and behavioural variables before the first advertising phase, (n = 1,544; August -September 2010), during (n = 1,500; February - March 2011) and after the advertising period (n = 1,500; June-July 2011). GHS usage data (n = 6,375) was collated during July 2010 - June 2011. RESULTS: The results showed that television-lead mass-media significantly increased unprompted awareness (0% to 31.8%, p < 0.001); prompted awareness (2.5% to 23.7%, p < 0.001); and understanding (10.2% to 32.2%, p < 0.001). Mass-media (television, print and mail out information) was more often cited as the source of referral by males, those aged 18 - 49 years, employed, and from the lowest socio-economic groups. During the weeks when mass-media advertising was present, 4 and 2.5 times more information and coaching participants respectively registered than when there was no advertising present. Participants who cited television and print were less likely to enrol in GHS coaching, but this was not the case for mail out information and secondary referral sources. CONCLUSIONS: GHS mass-communications campaigns are effective at increasing awareness and usage of the GHS, especially among hard-to-reach population groups. Television advertising provides universal reach, but should be supplemented by health professional referrals and targeted mail-out information to recruit participants to the intensive GHS coaching program.