Understanding and Changing Community Attitudes Toward Vulnerable Families: A Review of Literature and Practice.

Communities can play an important role in protecting children and supporting vulnerable families. However, there is currently a lack of understanding of what communities actually think and do regarding these groups. The purpose of this study was to review and synthesize evidence on community attitudes and behaviors toward vulnerable families. A rapid systematic literature review was conducted, supplemented by 6 semistructured interviews with experienced practitioners. Four databases were searched using key words related to community attitudes and behaviors, parents and families, and family and child protection services. Database searches returned 10 135 unique records, of which 23 met the inclusion criteria. The identified articles investigated a range of attitudes and behaviors, including reporting abuse and neglect; assisting victims of intimate partner violence; attitudes toward parenting practices; and participating in activities that build social support and social capital. Correlates of these attitudes and behaviors included sociodemographic characteristics, individual differences, community characteristics, and incident characteristics. A number of interventions to change community attitudes and behaviors were also identified. Practitioners indicated that success factors for interventions included facilitating active participation from community members; using multifaceted approaches; and increasing empathy toward vulnerable families. Despite increasing evidence around how community members think and act toward vulnerable families, more (particularly review-level) research is needed to determine how to effectively change these attitudes and behaviors.

From policy to practice: prioritizing person-centred healthcare actions in the state of Victoria.

BACKGROUND: Meaningful involvement of consumers in healthcare is a high priority worldwide. In Victoria, Australia, a Partnering in Healthcare (PiH) policy framework was developed to guide health services in addressing consumer-focused healthcare improvements. The aim of this project was to identify priorities for improvement relating to the framework from the perspective of Victorian healthcare consumers and those who work in the healthcare sector. METHODS: A survey of Victorians representing key stakeholder groups was used to identify a "long list" of potential priorities, followed by a day-long summit to reduce this to a "short list" using explicit prioritization criteria. The survey was piloted prior to implementation, and diverse consumer groups and key health service providers were purposefully sampled for the summit. RESULTS: The survey (n = 680 respondents) generated 14-20 thematic categories across the proposed framework's five domains. The summit (n = 31 participants, including n = 21 consumer representatives) prioritized the following five areas based on the survey findings: communication, shared decision-making, (shared) care planning, health (system) literacy and people (not) around the patient. These priorities were underpinned by three cross-cutting principles: care/compassion/respect, accountability and diversity. CONCLUSION: Few studies have explicitly sought consumer input on health policy implementation. Adopting a codesign approach enabled the framework to be a shared foundation of healthcare improvement. The framework was subsequently launched in 2019. All Victorian health services are required to commit annually to improvement priorities against at least two framework domains.

The construct validity of the multidimensional AIMES connection to nature scale: Measuring human relationships with nature.

Over the last decades, a plethora of nature connectedness measures have been developed, including unidimensional scales and others claiming to be multidimensional scales. Recently, Ives et al. (2018) conceptualised connection with nature as five general categories including attachment, cognition/identity, materialistic consumption, experiential components, and spiritual connection to nature. The current research presents a theory-driven approach to scale construction capturing the five factors similar to those described by Ives et al. (2018); the AIMES scale. The scale was developed in cooperation with practitioners and academics working in the field of human-nature interactions and its construct validity was tested with a representative sample of 3090 Victorians. Confirmatory factor analysis reinforced the five-factor model, showing that all factors correlated but were statistically distinct from one another. The second-order factor model also provided support for connection with nature as an overarching variable that can find expression to various degrees in the five primary factors. Finally, we found associations between the AIMES-factors and conceptually related measures of environmental values, environmental behaviours, environmental awareness, and time spent in nature. A short version of the scale is also presented for use in evaluation where brevity is required without compromising reliability and validity.

Ambulances are for emergencies: shifting behaviour through a research-informed behaviour change campaign.

BACKGROUND: A major review of Victoria's ambulance services identified the need to improve public awareness of the role of ambulances as an emergency service. A communications campaign was developed to address this challenge. This research paper expands on an initial evaluation of the campaign by focusing on the long-term behavioural outcomes. METHODS: The behavioural evaluation involved two types of data collection - administrative data (routine collection from various health services) and survey data (cross-sectional community-wide surveys to measure behavioural intentions). RESULTS: Behavioural intentions for accessing two of the targeted non-emergency services increased after the second phase of the campaign commenced. There was also a significant change in the slope of call trends for emergency ambulances. This decrease is also likely attributed to the second phase of the campaign as significant level effects were identified 3 and 9 months after it commenced. CONCLUSIONS: A long-term campaign developed through evidence review, stakeholder consultation and behavioural theory was successful in reducing the number of daily calls requesting an emergency ambulance in Victoria and in increasing intentions to use alternative services. This research highlights the importance of collaborative intervention design along with the importance of implementing a robust monitoring and evaluation framework.

Digital Inclusion & Health Communication: A Rapid Review of Literature.

Information and communication technologies can be a valuable tool for enhancing health communication. However, not everyone is utilising the wide suite of digital opportunities. This disparity has the potential to exacerbate existing social and health inequalities, particularly among vulnerable groups such as those who are in poor health and the elderly. This review aimed to systematically identify the common barriers to, and facilitators of, digital inclusion. A comprehensive database search yielded 969 citations. Following screening, seven systematic reviews and three non-systematic reviews were identified. Collectively, the reviews found that physical access continues to be a barrier to digital inclusion. However, provision of access alone is insufficient, as digital ability and attitude were also potential barriers. Social support, direct user experience and collaborative learning/design were identified as key strategies to improve inclusion. These review findings provide guidance for health communication practitioners in designing and implementing effective programmes in the digital environment.

Ambulances are for emergencies: shifting attitudes through a research-informed behaviour change campaign.

BACKGROUND: In Victoria, Australia, emergency calls requesting an ambulance have been increasing at a rate higher than population growth. While most of these calls are for genuine emergencies, many do not require an immediate ambulance response. A collaborative research approach was undertaken to address this issue. The aim of this paper was to evaluate the effectiveness of applying a behaviour change approach to this challenge by first addressing antecedents of behaviour (attitudes, awareness and knowledge). METHODS: The project included a formative research phase to inform the design of a mass media campaign and subsequent evaluation of the campaign. RESULTS: Results indicated that the campaign was successful in increasing community attitudes towards ambulances as being for emergencies only, particularly among those familiar with the campaign material and with other health service options (such as telephone advice lines). CONCLUSIONS: These findings provide support for adopting the Forum approach to increase the chances that a mass media campaign will achieve its stated objectives. Recommendations for future campaign activities are discussed.

Retirement Confidence: Development of an Index.

Older workers who are confident about the changes accompanying retirement report higher well-being. We have developed an index to measure retirement confidence - the Retirement Confidence Index (RCI). A six-stage approach was used to develop the index items, including (i) a literature review to catalogue retirement confidence components; (ii) a consultation with a panel of experts to review the proposed indicators and combine components according to their meaning; (iii) normalisation of the selected components to make them comparable; (iv) weighting of the top-level dimensions using experts' judgement; (v) linear aggregation of the dimension scores according to their corresponding relative weight; and (vi) correlation of the composite score with a self-report measure of retirement confidence. Based on the review of the literature, a list of nine sub-components (financial literacy, financial attitude and behaviour, financial control, financial anxiety, physical health, mental health, social connectedness, goal setting for retirement and future uncertainties) was compiled. Subsequently, these components were grouped into four broad dimensions. Correlations between these dimensions (social, financial awareness and skills, health and well-being, and retirement awareness and planning dimensions) and the corresponding self-reported measures were as high as r = 0.555, r = 0.603, r = 0.591 and r = 0.569, reflecting 30.8%, 36.3%, 34.9% and 32.3% shared variance with the corresponding self-reported indices, respectively. The Retirement Confidence Index provides the foundation for future research to measure retirement confidence, with the aim of identifying deficient RCI dimensions and directing efforts to targeted policies to ensure older workers are confident about retirement.

Short Message Service Reminders to Parents for Increasing Adolescent Human Papillomavirus Vaccination Rates in a Secondary School Vaccine Program: A Randomized Control Trial.

PURPOSE: In Victoria (Australia), the human papillomavirus (HPV) vaccine is delivered within a state-wide secondary school vaccine program, administered by local government. This study aimed to test the hypothesis that sending a short message service (SMS) reminder to parents who had consented to their child's receiving the HPV vaccine would lead to greater uptake of the vaccine within the program. The secondary aim was to assess the effect of self-regulatory versus motivational message content in the SMS. METHODS: A randomized control trial design was used across 31 schools within seven local government areas. Parents of 4,386 consented adolescents were randomized into three study conditions: motivational SMS versus self-regulatory SMS versus no SMS. Follow-up extended beyond the final school visit to the end of the calendar year to capture those who may have attended a catch-up vaccination session. RESULTS: On the day of the final school visit, 85.71% of consented students in the control condition received the HPV vaccine, compared with 88.35% (2.64% point increase) in the motivational message condition, and 89.00% (3.29% point increase) in the self-regulatory message condition, χ2 (2, N = 4,386) = 8.31, p = .016. Both intervention messages were similarly effective at increasing vaccination rates. This effect was maintained in the extended follow-up period. CONCLUSIONS: The trial findings supported the hypothesis that SMS reminders to parents/guardians would lead to greater uptake of the HPV vaccine in adolescents participating in school-based vaccination. Also, this effect was observed whether we used a motivational or self-regulatory message framework. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12617001307392). Registration Date: September 12, 2017. Retrospectively registered.

Communication-based interventions for increasing influenza vaccination rates among Aboriginal children: A randomised controlled trial.

BACKGROUND: In Australia, the influenza vaccine is funded for Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) children aged 6 months to <5 years old. In Victoria, only 2% of Aboriginal children are vaccinated against influenza. OBJECTIVE: To evaluate whether sending a letter or sending a pamphlet directly to parents/guardians would improve influenza vaccine uptake amongst Aboriginal identified children. DESIGN: The study involved a multi-arm, parallel, randomised controlled trial with two intervention groups and one control group. PARTICIPANTS & SETTING: Participants included parents or guardians of Victorian children (aged 6 months to <5 years) who identified as Aboriginal. Households (n = 5534) were randomised (using a random number generator) to receive either a personalised letter (n = 1845), a pamphlet (n = 1845), or no direct communication (control) (n = 1844). The letter and the pamphlet were designed using the INSPIRE framework - a set of behaviour change techniques for action-oriented communication. MAIN OUTCOME MEASURE: The proportion of households where all eligible children received the influenza vaccine between 2 May 2017 and 1 September 2017. RESULTS: The control group's vaccination rate was 4.4%, higher than previous years. The pamphlet group achieved a similar vaccination rate (4.5%). The letter group's vaccination rate of 5.9% was significantly higher than the control group [χ2 (1, n = 3689) = 4.33, p = .037]. CONCLUSIONS: Sending a personalised letter directly to parents/guardians was an effective strategy for increasing influenza vaccination among Aboriginal children. The ineffectiveness of the pamphlet may be due to the lack of personalisation and the authority associated with the letter. Additional research is required to understand participant responses to the material. TRIAL REGISTRATION: This research was retrospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) on 13 September 2017 (ACTRN12617001315303).

The effect of O2 and CO2 on the dive behavior and heart rate of lesser scaup ducks (Aythya affinis): quantification of the critical PaO2 that initiates a diving bradycardia.

Lesser scaup ducks were trained to dive for short and long durations following exposure to various gas concentrations to determine the influence of oxygen (O2) and carbon dioxide (CO2) on diving behavior and heart rate. Compared with normoxia, hyperoxia (50% O2) significantly increased the duration of long dives, whereas severe hypoxia (9% O2) significantly decreased the duration of both short and long dives. Hypercapnia (5% CO2) had no effect on dive duration. Surface intervals were not significantly altered by the oxygen treatments, but significantly increased following CO2 exposure. Heart rate during diving was unaffected by hyperoxia and hypercapnia, but gradually declined in long dives after severe hypoxia. Thus, our results suggest that during the majority of dives, O2 and CO2 levels in lesser scaup ducks are managed through changes in diving behavior without any major cardiovascular adjustments, but below a threshold PaO2, a bradycardia is evoked to conserve the remaining oxygen for hypoxia sensitive tissues. A model of oxygen store utilization during voluntary diving was developed to estimate the critical PaO2 below which bradycardia is initiated (approximately 26 mmHg) and predicted that this critical PaO2 would be reached 19s into a dive after exposure to severe hypoxia, which corresponded exactly with the time of initiation of bradycardia in the severe hypoxia trials.