"It's no use saying it in English": A qualitative study exploring community leaders' perceptions of the challenges and opportunities with translating and interpreting COVID-19 related public health messaging to reach ethnic minorities in Australia.

BACKGROUND: The Australian Government implemented a range of public health response strategies and communication approaches to reduce the spread of COVID-19; however, concerns have been raised around a failure to sufficiently consider culturally and linguistically diverse (CaLD) communities in these processes. This research aimed to understand the factors that have impacted COVID-19 communication and engagement efforts during the pandemic from the perspective of key CaLD community and faith-based leaders. A further aim was to understand the processes that could be adopted to support future communication strategies, including promoting pandemic-related vaccines. APPROACH: This study included 29 key informant interviews with community and faith-based leaders in New South Wales, Australia. RESULTS: The overwhelming message from community leaders was a sense of shared responsibility between their organisations and governments in communicating pertinent and accurate COVID-19 related information to CaLD communities. They expressed a sense of duty to keep their community members safe. However, community leaders and others shouldered significant costs related to resources and time that need to be acknowledged by governments in preparing for future disease outbreaks. They felt that governments should consider: 1) improving communication between governments and CaLD organisations; 2) responding to the specific CaLD needs with greater agility; 3) foregrounding social media in their communication strategy; 4) reinvesting in local public health units to know their population; 5) developing a health ambassadors model program; 6) preparing a hybrid model of translators/interpreters to fill the gap; and, 7) reimagining vaccine information campaigns to target CaLD communities better. CONCLUSION: Given the technical details about the COVID-19 virus conveyed in government information campaigns and the media, ensuring the most vulnerable populations, including people from CaLD backgrounds, access clear, concise and timely public health messaging from governments and community organisations requires further attention.

Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial.

INTRODUCTION: The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS: Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL: Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY: The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.

Access to general practice for preventive health care for people who experience severe mental illness in Sydney, Australia: a qualitative study.

BACKGROUND: People with lived experience of severe mental illness (PWLE) live around 20years less than the general population. Most deaths are due to preventable health conditions. Improved access to high-quality preventive health care could help reduce this health inequity. This study aimed to answer the question: What helps PWLE access preventive care from their GP to prevent long-term physical conditions? METHODS: Qualitative interviews (n=10) and a focus group (n=10 participants) were conducted with PWLE who accessed a community mental health service and their carers (n=5). An asset-based framework was used to explore what helps participants access and engage with a GP. A conceptual framework of access to care guided data collection and analysis. Member checking was conducted with PWLE, service providers and other stakeholders. A lived experience researcher was involved in all stages of the study. RESULTS: PWLE and their carers identified multiple challenges to accessing high-quality preventive care, including the impacts of their mental illness, cognitive capacity, experiences of discrimination and low income. Some GPs facilitated access and communication. Key facilitators to access were support people and affordable preventive care. CONCLUSION: GPs can play an important role in facilitating access and communication with PWLE but need support to do so, particularly in the context of current demands in the Australian health system. Support workers, carers and mental health services are key assets in supporting PWLE and facilitating communication between PWLE and GPs. GP capacity building and system changes are needed to strengthen primary care's responsiveness to PWLE and ability to engage in collaborative/shared care.

Developing a climate change inequality health impact assessment for health services.

OBJECTIVES: To develop a Climate Change Inequality Health Impact Assessment (CCIHIA) framework for health services; to provide a systematic process for assessing potential unequal health impacts of climate change on vulnerable and marginalised populations and places; to support effective planning to address these impacts; and to develop contextually appropriate local strategies. Type of program: A collaborative interdisciplinary scoping research project involving two universities and two local health districts (LHDs) in New South Wales (NSW) to develop a CCIHIA framework. This work builds upon the health impact assessment (HIA) approach, which systematically assesses proposals' potential health and equity impacts by involving stakeholders in developing responses. METHODS: The project involved four main activities: understanding stakeholder requirements; conceptualising climate change vulnerability; considering the role of health services; and integrating findings into a conceptual framework. RESULTS: Stakeholders identified key functions that should be addressed across the framing, process and utility of the CCIHIA framework. The resulting conceptual framework outlines contexts and social stratification, the differential impacts of climate change (including factors influencing unequal impacts) and the health system's position, and also identifies key potential points of intervention. LESSONS LEARNT: The challenge of addressing the complexity of factors and resulting health impacts is reflected within the CCIHIA framework. While there are many intervention points within this framework for health services to address, many factors influencing unequal impacts are created outside the health sector's direct control. The framework's development process reflected the focus on collaboration and the interdisciplinary nature of climate change response. Ultimately, the CCIHIA framework is an assessment tool and an approach for prioritising inclusive, cross-cutting, multisector working, and problem-solving.

Five urban health research traditions: A meta-narrative review.

Urban health scholars explore the connection between the urban space and health through ontological perspectives that are shaped by their disciplinary traditions. Without explicit recognition of the different approaches, there are barriers to collaboration. This paper maps the terrain of the urban health scholarship to identify key urban health research traditions; and to articulate the main features distinguishing these different traditions. We apply a meta-narrative review guided by a bibliometric co-citation network analysis to the body of research on urban health retrieved from the Web of Science Core Collection. Five urban health research traditions were identified: (1) sustainable urban development, (2) urban ecosystem services, (3) urban resilience, (4) healthy urban planning, and (5) urban green spaces. Each research tradition has a different conceptual and thematic perspective to addressing urban health. These include perspectives on the scale of the urban health issue of interest, and on the conceptualisation of the urban context and health. Additionally, we developed a framework to allow for better differentiation between the differing research traditions based on (1) perspectives of the urban system as complicated or complex, (2) the preferred locus of change as a function of structure and agency and (3) the geographic scale of the urban health issue that is addressed. These dimensions have even deeper implications for transdisciplinary collaboration as they are underpinned by paradigmatic differences, rather than disciplinary differences. We conclude that it is essential for urban health researchers to reflect on the different urban health approaches and seek coherence by understanding their similarities and differences. Such endeavours are required to produce and interpret transdisciplinary knowledge for the goal of improving health by transforming urban systems.

What constitutes brilliant aged care? A qualitative study of practices that exceed expectation.

AIM: This study aimed to explore what constitutes brilliant aged care. BACKGROUND: Although many aged care services do not offer the care that older people and carers need and want, some perform better. Rather than focus on problems with aged care, this study examined brilliant aged care-practices that exceeded expectation. DESIGN: The methodology for this study was informed by grounded theory, underpinned by constructionism to socially construct meaning. METHODS: This study invited nominations for a Brilliant Award via a survey, and interviews with the nominees via web conference. After receiving survey responses from 10 nominators, interviews were conducted with 12 nominees. Data were analysed using reflexive thematic analysis and documented according to COREQ guidelines to optimise rigour and transparency. RESULTS: According to participants, brilliant aged care involved being relationally attuned to older people, a deep understanding of the older person, recognition of aged care as more than a job, innovative practices and permission to reprioritise. CONCLUSIONS: This study suggests that, in aged care, brilliance happens. It emphasises the importance of meaningful connections and relationships in aged care, where thoughtful acts acknowledge an older person's value and humanity as well as creativity and innovation. RELEVANCE TO CLINICAL PRACTICE: For those who manage and deliver aged care, the findings suggest that small practice changes can make a positive difference to older people. Brilliant aged care can involve acts of empathy; enthusiasm for aged care; innovative practices, even those that are small scale; and reprioritising workplace tasks to spend time with older people. For policymakers, this study highlights the need to recognise and raise the profile of the pockets of brilliance within the aged care sector. This might be achieved via awards and other initiatives that serve to celebrate and learn from brilliance in its myriad forms. PATIENT OR PUBLIC CONTRIBUTION: The nominees, who included carers, were invited to participate in workshops with other carers and older people to co-design a model of brilliant aged care, during which workshop participants discussed and critiqued the findings constructed from the data.

Communication and engagement of community members from ethnic minorities during COVID-19: a scoping review.

OBJECTIVES: This review examined the factors influencing communication and engagement with ethnic and racial minority groups in Australia during the COVID-19 pandemic. It aimed to answer two main questions: (1) what communication problems people from these communities typically faced during the pandemic? and (2) what strategies and recommendations were suggested to enhance communication and engagement for ethnic and racial minorities during the current COVID-19 pandemic and any similar events in the future? DESIGN: Scoping review. DATA SOURCES: PubMed, EMBASE, Cochrane Library, PsychINFO and CINAHL. Grey literature was searched within organisations' websites and a Google search of key terms. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included original research, case studies, reports (including government and charity reports), systematic and scoping articles and literature reviews in English, published from January 2020 to August 2022. DATA EXTRACTION AND SYNTHESIS: Two researchers independently assessed the literature for eligibility and extracted data from the included literature. The selected papers were analysed and summarised into themes relevant to the research questions. The final review included 38 studies combining published academic papers and grey literature. RESULTS: Key themes relating to communication and engagement issues included a lack of trust in authority, a lack of access to information and ineffective communication channels and a lack of timely and culturally responsive materials. To reduce the issues, the papers spoke about the key role of community organisations to provide local support and community leaders as trusted spokespersons. Lastly, key recommendations to reduce inequity and strengthen future pandemic responses focused on the need for collaborations and consultations, increasing the number of bilingual workers and supporting community-led communication efforts. CONCLUSIONS: The insights gained from the activities and experiences documented in this review during the COVID-19 pandemic should be incorporated into future decision-making and interventions to enhance communication and engagement strategies.

Translating Health Coaching Training into Clinical Practice.

Health coaching can benefit people with managing chronic conditions. It considers people's motivations, is person-centred and has the capacity to promote healthy lifestyles and address chronic disease risk factors. However, how health coaching training is translated into routine clinical practice at unit and service levels has been under explored. A metropolitan local health district in Sydney, Australia provided coaching training to health professionals, but the extent to which coaching skills were translated into clinical practice was unknown. A redesign methodology was used to identify barriers and facilitators for training-to-practice translation. Survey and workshop findings indicated that participants were satisfied with the coaching training but found it challenging to apply in clinical practice. Identified opportunities to support the application of health coaching were tailored practical training, post training support, and consensus on the definition of health coaching. Solutions were to develop an internal practical training program, use consistent terminology, and embed organisational support. Adoption of health coaching needs to occur on three levels; individual, workplace and organisation to ensure effective health care delivery. This case study demonstrates the importance of evaluation and diagnostics of contextual barriers and enablers to inform translation into practice.

Attitudes towards the 'Shisha No Thanks' campaign video: Content analysis of Facebook comments.

INTRODUCTION: While social media are commonly used in public health campaigns, there is a gap in our understanding of what happens after the campaign is seen by the target audience. This study aims to understand how the Shisha No Thanks campaign video was received by the Facebook audience by analyzing Facebook comments posted to it. Specifically, this study aims to determine whether the Facebook audience accepted or rejected the campaign's message. METHODS: A sample of the Facebook comments was extracted, and the study team, which included cultural support workers, developed content categories consistent with the research question. Each comment was then coded by three team members, and only assigned a category if there was agreement by at least two members. RESULTS: Of the 4990 comments that were sampled, 9.1% (456) accepted the campaign message, 22.9% (1144) rejected the message, 21.8% (1089) were unclear, and 46.1% (2301) contained only tagged names. Of the sample, 2.8% (138) indicated the commenter took on board the campaign message by expressing an intention to stop smoking shisha, or asking a friend to stop smoking shisha. Of the comments that showed rejection of the campaign, the majority were people dismissing the campaign by laughing at it or expressing pro-shisha sentiments. CONCLUSIONS: This study demonstrates that conducting content analyses of social media comments can provide important insight into how a campaign message is received by a social media audience.

Diagnosing and managing patients with chronic pain who develop prescription opioid use disorder: A scoping review of general practitioners' experience.

BACKGROUND AND OBJECTIVES: Prescription opioid use disorder (pOUD) is an important sequela of long-term prescribed opioids for chronic pain. General practitioners (GPs) may not systematically diagnose or manage this; however, it is unclear why. METHOD: This scoping review searched multiple databases to assess GPs' experience diagnosing and managing patients prescribed opioids for chronic pain who have developed pOUD. RESULTS: The 19 included articles report high levels of GP concern regarding opioid diversion, inappropriate use, abuse, misuse, diversion, dependence and addiction. Confidence screening and detecting pOUD is mixed, and few screen systematically. The most common response is declining to prescribe rather than diagnosing and managing pOUD. DISCUSSION: GPs experience high levels of conflict when considering potential pOUD in their patients with chronic pain prescribed opioids. Their experiences diagnosing and managing pOUD are not fully understood. Further theory-based research may help to understand this and assist future policy directions, programs and research priorities.

Defining community health services in Australia: a qualitative exploration.

BACKGROUND: The Community Health Program of the 1970s was an attempt to introduce a national community health model. However, although community-based health care is an important element of the health systems of all Australian states and territories, the definition of what constitutes a 'community health service' in Australia today is not clear. METHODS: A search of government websites failed to provide information about the types and characteristics of services that would be included in the term. Therefore, semi-structured interviews were conducted with 13 key informants in roles with responsibility for primary and community health services from health departments in all Australian states and territories. Questions explored their understanding of community health services as they operated in their jurisdiction. The study adopted a blended inductive and deductive orientation within a qualitative descriptive method. RESULTS: There was little consistency in the way community health services were described across jurisdictions. The defining attributes of a 'community health centre' described by an international peak body did not apply to services in the majority of jurisdictions in Australia. Victoria was more aligned with the description than other jurisdictions, with organisations defined through legislation and a separate funding stream to support aspects of service delivery. CONCLUSIONS: Those designing and implementing national health system programs and reforms need to be aware that terms, such as 'community health', do not mean the same thing across jurisdictions; attempts to create consistency have to recognise differences that will affect new initiatives, as well as the spread of successful policies and programs from one jurisdiction to another. Without a consistent description, it is difficult to explore the current role of community-based health care across Australia in improving access to health care.

Inequity in Access and Delivery of Virtual Care Interventions: A Scoping Review.

The objectives of this review were to map and summarize the existing evidence from a global perspective about inequity in access and delivery of virtual care interventions and to identify strategies that may be adopted by virtual care services to address these inequities. We searched MEDLINE, EMBASE, and CINAHL using both medical subject headings (MeSH) and free-text keywords for empirical studies exploring inequity in ambulatory services offered virtually. Forty-one studies were included, most of them cross-sectional in design. Included studies were extracted using a customized extraction tool, and descriptive analysis was performed. The review identified widespread differences in accessing and using virtual care interventions among cultural and ethnic minorities, older people, socioeconomically disadvantaged groups, people with limited digital and/or health literacy, and those with limited access to digital devices and good connectivity. Potential solutions addressing these barriers identified in the review included having digitally literate caregivers present during virtual care appointments, conducting virtual care appointments in culturally sensitive manner, and having a focus on enhancing patients' digital literacy. We identified evidence-based practices for virtual care interventions to ensure equity in access and delivery for their virtual care patients.

Respiratory pandemics, urban planning and design: A multidisciplinary rapid review of the literature.

COVID-19 is the most recent respiratory pandemic to necessitate better knowledge about city planning and design. The complex connections between cities and pandemics, however challenge traditional approaches to reviewing literature. In this article we adopted a rapid review methodology. We review the historical literature on respiratory pandemics and their documented connections to urban planning and design (both broadly defined as being concerned with cities as complex systems). Our systematic search across multidisciplinary databases returned a total of 1323 sources, with 92 articles included in the final review. Findings showed that the literature represents the multi-scalar nature of cities and pandemics - pandemics are global phenomena spread through an interconnected world, but require regional, city, local and individual responses. We characterise the literature under ten themes: scale (global to local); built environment; governance; modelling; non-pharmaceutical interventions; socioeconomic factors; system preparedness; system responses; underserved and vulnerable populations; and future-proofing urban planning and design. We conclude that the historical literature captures how city planning and design intersects with a public health response to respiratory pandemics. Our thematic framework provides parameters for future research and policy responses to the varied connections between cities and respiratory pandemics.

Speaking COVID-19: supporting COVID-19 communication and engagement efforts with people from culturally and linguistically diverse communities.

BACKGROUND: Since the emergence of COVID-19, issues have been raised regarding the approach used to engage with Culturally and Linguistically Diverse (CaLD) communities during this public health crisis. This study aimed to understand the factors impacting communication and engagement efforts during the COVID-19 pandemic from the perspective of crucial CaLD community stakeholders and opinion leaders. METHODS: Forty-six semi-structured telephone interviews were undertaken with key stakeholders who have an active role (established before the pandemic) in delivering services and other social support to CaLD communities in Australia. RESULTS: Seven key themes emerged: (1) the digital divide and how to connect with people; (2) information voids being filled by international material; (3) Differentiating established with new and emerging communities' needs; (4) speaking COVID-19; (5) ineffectiveness of direct translations of English language resources; (6) coordination is needed to avoid duplication and address gaps and (7) recognising the improvements in governments' approach. CONCLUSION: Alliances must be set up that can be activated in the future to reduce issues around resource development, translation, and dissemination of messages to minimise gaps in the response. Financial assistance must be provided in a timely way to community organisations to support the development and dissemination of culturally appropriate communication materials.

Frequent users of health services among community-based older Australians: Characteristics and association with mortality.

OBJECTIVES: To investigate characteristics of frequent users of general practice (GP; ≥21 visits in a year), medical specialist (≥10 visits), emergency department (ED; ≥2 presentations) and hospital services (≥2 overnight hospitalisations) and the association with mortality for people aged over 75 years. METHODS: The study included residents from Central and Eastern Sydney, Australia, aged over 75 years who participated in a large community-dwelling cohort study. Demographic, social and health characteristics data were extracted from the 45 and Up Study survey. Health service (GP, medical specialist, ED and hospitalisations) use and mortality data were extracted from linked administrative data. We calculated adjusted prevalence ratios to identify independent characteristics associated with frequent users of services at baseline (approx. 2008) and adjusted hazard ratios to assess the association between frequent users of services and mortality. RESULTS: Frequent users of services (GPs, medical specialists, EDs and hospitals) were more likely to be associated with ever having had heart disease and less likely to be associated with reporting good quality of life. Characteristics varied by service type. Frequent users of services were 1.5-2.0 times more likely to die within 7 years compared to those who were less frequent service users after controlling for all significant factors. CONCLUSIONS: Our analysis found that frequent service users aged over 75 years had poorer quality of life, more complex health conditions and higher mortality and so their health service use was not inappropriate. However, better management of these frequent service users may lead to better health outcomes.

Strengths and risks of the Primary Health Network commissioning model.

Objective To explain how the Primary Health Network commissioning model works, and factors likely to affect its success. Methods The study focuses on the delivery of primary healthcare services by one Primary Health Network (PHN) in Australia. The qualitative case study is informed by a desk top review, interviews (n = 49) and observations with key stakeholders involved in commissioning and delivering primary healthcare services in the region. Results The study provides several insights about the PHN model. First, conceptually, the PHN commissioning model is well suited to identifying and meeting local primary healthcare priorities, bringing together a range of stakeholders involved in healthcare provision. Second, although primary healthcare services are difficult to specify and measure, PHN staff use their content knowledge and experience, and relationships with providers and the community, to design services that meet the needs of consumers. Third, the success of this model may be undermined by short funding cycles and short lead-times, a focus on national rather than local priorities, and continual reductions in operational funding. This may result in more procedural forms of contract management, which may mean that changes in service need, provision and quality go unnoticed. Conclusions This study shows that although clever in design, the PHN model may not meet its full potential. Given continual changes to the model, including funding, further independent research should be undertaken to understand how PHNs adjust and whether services continue to meet the needs of the local community.