Education of the public health workforce and the Sustainable Development Goals: An analysis of existing competency sets.

Objectives: This paper describes a project designed to quantify the extent to which existing competency frameworks used for educating the public health workforce contribute to achieving the Sustainable Development Goals (SDGs) directly relevant to public health. Study design: This was a qualitative study involving a content and thematic analysis and mapping of nine available public health competency sets against the World Federation of Public Health Association's Global Charter for the Public's Health and the SDGs. Methods: First, the SDG targets directly relevant to public health were selected, then mapped against the elements of the Global Charter to illustrate their alignment with aspects of public health practice. Next, competencies from each respective framework were mapped against the SDG targets, and the results quantified as to the coverage of the SDG targets by each of the frameworks. Results: Overall, very few competencies directly or fully covered the SDG targets in question, however, there were more competencies partially covering the targets. Except for one framework, many issues found in the SDG targets were not explicitly addressed by the competencies in most of the frameworks, namely, migration, human rights, violence, and food and water scarcity. Conclusions: Overall, urgent action is required to ensure public health competency frameworks are more in line with the SDGs and include public health issues that disproportionally affect low- and middle-income countries.

Mapping competency frameworks: implications for public health curricula design.

OBJECTIVES: We discuss the implications stemming from a recent competency mapping project on public health workforce education and training programs. METHODS: In line with professional practice, we reflected on the results of a major mapping exercise which examined public health competency frameworks against the Global Charter, particularly with respect to the implications for curriculum design. RESULTS: Our reflections identified five key challenges (diversity of frameworks, interpretation challenges, levels of competence, integration in curricula and knowledge vs skills-based competences) for developing internationally consistent credentialling standards. CONCLUSIONS: While the Charter provides an international benchmark for public health curricula, we argue that applying an international competency framework is challenging. Anyone working in public health should be trained in all foundation areas of public health to support public health practice and initiatives into the future and they may then choose to specialise in sub-disciplines of public health. IMPLICATIONS FOR PUBLIC HEALTH: Both theoretical and practical content must be fully integrated across public health programs to operationalise competencies. Utilising the Charter can ensure alignment with the sector needs, and curriculum mapping should be an integral part of a continual and ongoing review process.

Practical competencies for public health education: a global analysis.

OBJECTIVES: We quantified the contents of existing public health competency frameworks against the elements of the World Federation of Public Health Associations' Global Charter for the Public's Health. METHODS: We conducted a desktop analysis of eight public health competency frameworks publicly available on the internet. Using a pre-formed template, competency statements from each framework were mapped against the elements of the Global Charter-core public health services (Protection, Promotion and Prevention) and overarching enabling functions (Information, Governance, Capacity, and Advocacy). We then quantified coverage of the Charter's elements in each of the frameworks. RESULTS: We found that although the public health competency frameworks vary considerably in terms of coverage and focus, they all cover every element contained in the Global Charter. However, there were a number of areas of competency identified in some frameworks not explicitly referred to in the Charter including cultural safety, human rights and systems thinking. CONCLUSIONS: The Global Charter provides a mechanism for comparing competency sets, checking public health curricula content, informing competency framework and curricula (re)design, and planning and monitoring workforce needs.

COVID-19-Extending Surveillance and the Panopticon.

Surveillance is a core function of all public health systems. Responses to the COVID-19 pandemic have deployed traditional public health surveillance responses, such as contact tracing and quarantine, and extended these responses with the use of varied technologies, such as the use of smartphone location data, data networks, ankle bracelets, drones, and big data analysis. Applying Foucault's (1979) notion of the panopticon, with its twin focus on surveillance and self-regulation, as the preeminent form of social control in modern societies, we examine the increasing levels of surveillance enacted during this pandemic and how people have participated in, and extended, this surveillance, self-regulation, and social control through the use of digital media. Consideration is given to how such surveillance may serve public health needs and/or political interests and whether the rapid deployment of these extensive surveillance mechanisms risks normalizing these measures so that they become more acceptable and then entrenched post-COVID-19.

Risk factors for renal disease and diabetes in remote Australia - findings from The Western Desert Kidney Health Project.

INTRODUCTION: The Western Desert Kidney Health Project (WDKHP) aimed to determine the prevalence of type 2 diabetes (T2DM), kidney disease and associated risk factors in Aboriginal and non-Aboriginal people in a remote area of Western Australia. METHODS: The project, featuring whole-of-community cross-sectional surveys and health assessments using point-of-care testing, was conducted in five small towns and six remote Aboriginal communities in the Goldfields of Western Australia between 2010 and 2014. Initial health assessments were completed by 597 adults (424 Aboriginal) and 502 children (393 Aboriginal). This included almost 80% of the Aboriginal population. All non-Aboriginal people residing in the six remote Aboriginal communities participated. RESULTS: Risk factors for renal disease and T2DM were present in participants of all ages, including children as young as 2 years. There was no significant difference between Aboriginal and non-Aboriginal children. Aboriginal and non-Aboriginal adult participants had twice the burden of T2DM than the standard Australian population. More than 12% of all children had elevated albumin-creatinine ratio (ACR). Adults had markers of kidney disease at higher rates than expected: 51% of Aboriginal adults and 27% of non-Aboriginal adults had at least one marker of kidney disease (haematuria, proteinuria or elevated ACR). Aboriginal women were the highest risk group (32% T2DM, 40% elevated ACR). Haematuria and low urine pH were common findings, 21% of people had haematuria (greater than trace) and 71% had urine pH of 6 or less; there was no difference in this finding between Aboriginal and non-Aboriginal people. CONCLUSION: The WDKHP found higher than expected rates of risk factors for T2DM and renal disease compared with Australian Bureau of Statistics rates for Australian Aboriginal and non-Aboriginal adults and children, with Aboriginal women the highest risk group. The rates for non-Aboriginal participants were higher than expected, suggesting exposures in common might be more important than ethnicity.The high prevalence of aciduria and haematuria found in both Aboriginal and non-Aboriginal participants in this study suggests that factors contributing to a chronic metabolic acidosis and inflammation or irritation of the urinary tract need to be explored. Drinking water quality in this remote area is known to be poor and may be an important contributing factor. Many of the contributing factors are potentially modifiable - such as water quality, food supply, exercise opportunities and living conditions - offering scope for interventions to reduce the risk and burden of these diseases.

Educating for Indigenous public health competence - how do we stack up in Australia?

OBJECTIVE: Internationally, work is underway to develop or revise public health graduate competencies, of which Indigenous public health competencies are a subset in Australia. This paper outlines the summative results from a review of Master of Public Health (MPH) programs undertaken to determine the level of coverage of Indigenous health in core content and to explore factors that influence the extent of integration. METHODS: Of the 22 Australian universities offering an MPH program at the commencement of this study, seven were eventually reviewed using a mixed methods approach. RESULTS: Results showed varying levels of relevant content in both core and elective subjects. Not all reviewed universities taught all the competencies in their core curriculum and some universities did not cover all the competencies in either the core or elective subjects. CONCLUSION: These findings highlight the need for inclusion of the Indigenous public health competencies to be made obligatory in MPH programs. Implications for public health: Significant gaps remain in public health curricula enabling students to develop competencies that enable them to become judgement safe practitioners when working with Indigenous peoples and communities. A revised curriculum framework document provides a range of useful strategies and resources to remedy these omissions.

Men's weight loss stories: How personal confession, responsibility and transformation work as social control.

Obesity is considered a public health concern. In Australia, there are a greater number of overweight or obese men compared with women. The media is an important source of information about body weight and weight management. We undertook a qualitative study to analyse men's weight loss stories in a popular men's magazine. Between January 2009 and December 2012, we collected 47 men's weight loss stories from the Australian edition of Men's Health magazine. We undertook thematic analysis to examine the stories. Confession, personal responsibility, appearance and transformation were key themes. The stories describe the men's self-discipline and their monitoring and tracking of their behaviours as activities which supported their weight loss. In this way, the stories promote the importance of such panoptic self-surveillance and self-discipline to the readers. We consider how such stories contribute to the wider synoptic system of media messages about body weight.

Media portrayal of elite athletes with disability - a systematic review.

BACKGROUND: The media plays an important role in shaping society's beliefs about disability and sport. The aim of this systematic review is to identify how elite athletes with disability are portrayed in the media. METHOD: Six electronic databases were searched from 2001 to March 2017 for quantitative or qualitative content analysis of media coverage of elite athletes with disability: SportsDiscus, CINAHL, PsychInfo, Medline 1996-, Embase, and Proquest. Quality assessment and data extraction were performed by two independent assessors. RESULTS: Seventeen moderate quality articles were included. Six themes emerged from the data such as frequency of articles and photos about elite athletes with disability; athlete gender; athlete nationality; disability; athleticism; and Olympic Games versus Paralympic Games. Our results show that elite athletes with disability are less visible in the media than their nondisabled counterparts; female athletes received less coverage than male; the media favored domestic athletes and certain types of disability; and, although there was a focus on athleticism, this was underpinned by a "supercrip" narrative and a medicalised description of disability. CONCLUSION: Although there has been a positive shift in the narrative around elite athletes with disability in media, relative absence and differing portrayal is present. Considering the power of media shaping society's perceptions of disability, further investigation is warranted. Implications for Rehabilitation Media has a role in how elite athletes with disability are portrayed and consequently perceived by the public. Elite athletes with disability rarely feature in media. Images of disability are minimized, and certain types of disabilities are favored. An athletic narrative is emerging; however, a medicalised description of athletes remains, shifting the focus from athleticism. "Supercrip" and "Superhuman" terms are commonly used, but may negatively impact the broader disability community.

Face-to-face interventions for informing or educating parents about early childhood vaccination.

BACKGROUND: Early childhood vaccination is an essential global public health practice that saves two to three million lives each year, but many children do not receive all the recommended vaccines. To achieve and maintain appropriate coverage rates, vaccination programmes rely on people having sufficient awareness and acceptance of vaccines.Face-to-face information or educational interventions are widely used to help parents understand why vaccines are important; explain where, how and when to access services; and address hesitancy and concerns about vaccine safety or efficacy. Such interventions are interactive, and can be adapted to target particular populations or identified barriers.This is an update of a review originally published in 2013. OBJECTIVES: To assess the effects of face-to-face interventions for informing or educating parents about early childhood vaccination on vaccination status and parental knowledge, attitudes and intention to vaccinate. SEARCH METHODS: We searched the CENTRAL, MEDLINE, Embase, five other databases, and two trial registries (July and August 2017). We screened reference lists of relevant articles, and contacted authors of included studies and experts in the field. We had no language or date restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs evaluating the effects of face-to-face interventions delivered to parents or expectant parents to inform or educate them about early childhood vaccination, compared with control or with another face-to-face intervention. The World Health Organization recommends that children receive all early childhood vaccines, with the exception of human papillomavirus vaccine (HPV), which is delivered to adolescents. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Two authors independently reviewed all search results, extracted data and assessed the risk of bias of included studies. MAIN RESULTS: In this update, we found four new studies, for a total of ten studies. We included seven RCTs and three cluster-RCTs involving a total of 4527 participants, although we were unable to pool the data from one cluster-RCT. Three of the ten studies were conducted in low- or middle- income countries.All included studies compared face-to-face interventions with control. Most studies evaluated the effectiveness of a single intervention session delivered to individual parents. The interventions were an even mix of short (ten minutes or less) and longer sessions (15 minutes to several hours).Overall, elements of the study designs put them at moderate to high risk of bias. All studies but one were at low risk of bias for sequence generation (i.e. used a random number sequence). For allocation concealment (i.e. the person randomising participants was unaware of the study group to which participant would be allocated), three were at high risk and one was judged at unclear risk of bias. Due to the educational nature of the intervention, blinding of participants and personnel was not possible in any studies. The risk of bias due to blinding of outcome assessors was judged as low for four studies. Most studies were at unclear risk of bias for incomplete outcome data and selective reporting. Other potential sources of bias included failure to account for clustering in a cluster-RCT and significant unexplained baseline differences between groups. One cluster-RCT was at high risk for selective recruitment of participants.We judged the certainty of the evidence to be low for the outcomes of children's vaccination status, parents' attitudes or beliefs, intention to vaccinate, adverse effects (e.g. anxiety), and immunisation cost, and moderate for parents' knowledge or understanding. All studies had limitations in design. We downgraded the certainty of the evidence where we judged that studies had problems with randomisation or allocation concealment, or when outcomes were self-reported by participants who knew whether they'd received the intervention or not. We also downgraded the certainty for inconsistency (vaccination status), imprecision (intention to vaccinate and adverse effects), and indirectness (attitudes or beliefs, and cost).Low-certainty evidence from seven studies (3004 participants) suggested that face-to-face interventions to inform or educate parents may improve vaccination status (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.04 to 1.37). Moderate-certainty evidence from four studies (657 participants) found that face-to-face interventions probably slightly improved parent knowledge (standardised mean difference (SMD) 0.19, 95% CI 0.00 to 0.38), and low-certainty evidence from two studies (179 participants) suggested they may slightly improve intention to vaccinate (SMD 0.55, 95% CI 0.24 to 0.85). Low-certainty evidence found the interventions may lead to little or no change in parent attitudes or beliefs about vaccination (SMD 0.03, 95% CI -0.20 to 0.27; three studies, 292 participants), or in parents' anxiety (mean difference (MD) -1.93, 95% CI -7.27 to 3.41; one study, 90 participants). Only one study (365 participants) measured the intervention cost of a case management strategy, reporting that the estimated additional cost per fully immunised child for the intervention was approximately eight times higher than usual care (low-certainty evidence). No included studies reported outcomes associated with parents' experience of the intervention (e.g. satisfaction). AUTHORS' CONCLUSIONS: There is low- to moderate-certainty evidence suggesting that face-to-face information or education may improve or slightly improve children's vaccination status, parents' knowledge, and parents' intention to vaccinate.Face-to-face interventions may be more effective in populations where lack of awareness or understanding of vaccination is identified as a barrier (e.g. where people are unaware of new or optional vaccines). The effect of the intervention in a population where concerns about vaccines or vaccine hesitancy is the primary barrier is less clear. Reliable and validated scales for measuring more complex outcomes, such as attitudes or beliefs, are necessary in order to improve comparisons of the effects across studies.

From problem people to addictive products: a qualitative study on rethinking gambling policy from the perspective of lived experience.

BACKGROUND: Previous research has shown that government and industry discussions of gambling may focus on personal responsibility for gambling harm. In Australia, these discussions have largely excluded people with lived experience of problem gambling, including those involved in peer support and advocacy. METHODS: We conducted 26 in-depth interviews with people with current or previous problem gambling on electronic gaming machines (EGMs) involved in peer support and advocacy activities, using an approach informed by Interpretive Policy Analysis and Constructivist Grounded Theory. RESULTS: Participants perceived that government and industry discussed gambling as safe and entertaining with a focus on personal responsibility for problem gambling. This focus on personal responsibility was perceived to increase stigma associated with problem gambling. In contrast, they described gambling as risky, addictive and harmful, with problem gambling resulting from the design of EGMs. As a result of their different perspectives, participants proposed different interventions to reduce gambling harm, including reducing accessibility and making products safer. CONCLUSIONS: Challenging the discourses used by governments and industry to describe gambling, using the lived experience of people with experience of gambling harm, may result in reduced stigma associated with problem gambling, and more effective public policy approaches to reducing harm.

Women's experiences of, and attitudes to, maternity education across the perinatal period in Victoria, Australia: A mixed-methods approach.

BACKGROUND: While the provision of maternity education across the perinatal period can increase the confidence and self-efficacy in childbearing women, there is still thought to be a lack of effective educational resources for parenthood. This study, conducted in Victoria, Australia, investigated women's experiences of, and attitudes to education communicated in maternity service provision. METHODS: 189 women were recruited from a variety of settings to participate in a mixed-methods survey about their experiences of perinatal health service education. FINDINGS: Of the sample of childbearing women, 153 (81%) reported attending antenatal classes. Women perceived their antenatal education as beneficial, though many women still felt unprepared beyond labour and birth. With respect to the hospital postnatal stay, findings suggested a variation among the content imparted to women across different Victorian maternity services, (e.g. rural women tended to be more dissatisfied with information received in relation to maternal emotional and physical health). Overall, women wished they had been more informed about breastfeeding and settling techniques, while a lack of information relating to social support initiatives for the postnatal period was also indicated. Women reported that they were missing educational and practical reinforcement of mothercraft skills. CONCLUSIONS: There is a need for a reorientation of perinatal health service education. A health promotion approach is suggested as it extends beyond the physical recovery from birth to encompass psychosocial factors; including perinatal morbidities that can disrupt the quality and experience of the transition to parenthood.

Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal.

Behaviour change is central to the prevention of many population health problems, yet it is typically difficult to initiate and sustain. This paper reports on an evaluation of a water, sanitation and hygiene (WASH) intervention in mid-western Nepal, with particular focus on the drivers and barriers for handwashing with soap/ash and elimination of open defecation. The research was conducted during October-November 2014, two and half years following the intervention's end-point. Qualitative data were collected from the target community (n = 112) via group discussions, interviews and drawings/stories of 'most significant change'. Households' handwashing/water facilities and toilets were observed. Analysis was informed by a model that highlights environmental, psychosocial and technological factors that shape hygiene behaviours across multiple levels, from the habitual to the structural (Dreibelbis et al. 2013). Findings indicate the intervention has supported development of new norms around hygiene behaviours. Key drivers of sustained hygiene behaviour were habit formation, emotional drivers (e.g. disgust, affiliation), and collective action and civic pride; key constraints included water scarcity and socio-economic disadvantage. Identifying and responding to the drivers and constraints of hygiene behaviour change in specific contexts is critical to sustained behaviour change and population health impact.