Social marketing and mass media interventions to increase sexually transmissible infections (STIs) testing among young people: social marketing and visual design component analysis.

INTRODUCTION: Globally, sexually transmissible infections (STIs) continue to disproportionately affect young people. Regular STI testing is an important public health strategy but remains low among this age group. Raising awareness of testing is an essential step and requires effective interventions designed for young people. To inform the development of effective interventions that promote STI testing among young people, we conducted a systematic literature review to describe the social marketing and visual design components commonly found in STI testing interventions and explore associations of these components with intervention effectiveness. METHODS: We used a systemic review methodology to identify peer-reviewed articles that met pre-defined inclusion criteria. Social marketing and visual component analyses were conducted using structured data extraction tools and coding schemes, based on the eight key social marketing principles and 28 descriptive dimensions for visual analysis. RESULTS: 18 studies focusing on 13 separate interventions met the inclusion criteria. Most interventions used photograph-based images, using conventionally attractive actors, positioned centrally and making direct eye contact to engage the viewer. The majority of interventions featured text sparingly and drew on a range of tones (e.g. serious, humorous, positive, reassuring, empowering and informative) and three interventions used sexualised content. Four articles explicitly stated that the interventions was informed by social marketing principles, with two explicitly referencing all eight principles. Around half of the articles reported using a formal theoretical framework, but most were considered to have theoretical constructs implicit in interventions materials. Four articles provided detailed information regarding developmental consumer research or pre-testing. All articles suggested segmentation and development of materials specifically for young people. Explicit consideration of motivation and competition was lacking across all articles. This study found that there were some design elements common to interventions which were considered more effective. High social marketing complexity (where interventions met at least seven of the 11 criteria for complexity) seemed to be associated with more effective interventions. CONCLUSIONS: Our findings suggest that the incorporation of social marketing principles, could be more important for intervention effectiveness than specific elements of visual design. Effective and systematic use of social marketing principles may help to inform future evidence-informed and theoretically based interventions and should be employed within sexual health improvement efforts.

Evaluating an online module for sexual violence prevention in a tertiary educational setting: An exploratory study.

ISSUE ADDRESSED: Sexual violence is an important public health issue affecting significant numbers of university students across Australia and internationally. In response, online modules have been widely implemented and there is an urgent need to better understand their effectiveness. The aim of this study was to evaluate an online sexual violence prevention and response education module designed for and implemented in one Australian university. METHODS: We used a mixed-methods approach that included pre/post module completion surveys of key measures relating to sexual consent, being a bystander, and response to disclosures as well as knowledge of resources and support services. We conducted post module completion semi-structured interviews. RESULTS: Results indicated potential effectiveness of the module on beliefs about sexual consent, confidence intervening when witnessing potentially harmful situations, willingness to report incidents, confidence supporting a peer who discloses an incident, and knowledge of support services. Qualitative results indicated support for the online module as an accessible, private and self-paced tool for sexual violence education. Interactive, relevant and engaging content that can be applied in real-life contexts was noted as key for effectiveness. CONCLUSIONS: This exploratory study suggests there may be potential for online modules to be effective, as one aspect of universities' sexual violence prevention and response strategies-particularly modules aimed at addressing primary, secondary and tertiary prevention. Further rigorous research is required to strengthen best practice in the development and implementation of online modules as part of whole-of-campus strategies. SO WHAT?: Universities across Australia and internationally are grappling with sexual violence response and prevention in light of high prevalence rates among students. Online modules may be one effective tool when implemented as part of a wider strategy.

Group Therapy for Survivors of Adult Sexual Assault: A Scoping Review.

Across the world, women experience significant rates of sexual assault and there is a need to strengthen support services offered to survivors. Group therapy could provide an important addition to services that support healing and growth; however, the effectiveness of group therapy interventions with survivors of adult sexual assault is not well understood and clearer insights into designing and running group therapy interventions require further exploration. This review synthesizes literature exploring group therapy for survivors of adult sexual assault to inform future interventions and research implementing group therapy. A systematic approach was used to gather literature describing and evaluating group therapy interventions with survivors of adult sexual assault. Of the initial 466 articles identified through a comprehensive search strategy including database and hand searches, 32 met the inclusion criteria by describing a group therapy intervention conducted with survivors of adult sexual assault. A thematic approach to analysis was conducted to synthesize and collate the literature. Findings explore potentially useful strategies and characteristics of group therapy with survivors of adult sexual assault and make recommendations for the design and evaluation of future interventions. Group therapy has potential as a valuable support service provided to survivors but further rigorous research and evaluations are required to better capture outcomes and understand how to design and implement effective interventions.

Promoting Compassionate Responses to Disclosures of Sexual Violence in University Settings: Exploring the Impact of a Social Marketing Campaign.

This study explores a social marketing campaign aimed to promote compassionate responses to disclosures of sexual violence from peers and raise awareness of university-based formal support services. Findings from a survey (n = 189) and follow-up focus groups (n = 11) conducted with university students in Australia indicated that exposure to the campaign may support students' self-perceived confidence in responding compassionately to disclosures of sexual violence and raise awareness of university-based formal support services. These findings suggest social marketing may be a useful tool to form part of universities' sexual violence response and prevention strategies. These findings may help inform future university campaigns.

How can general practitioners support people who inject drugs to engage with direct-acting antiviral treatment for hepatitis C? A qualitative study.

BACKGROUND AND OBJECTIVES: General practitioners (GPs) have an important role to play in increasing direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) among people who inject drugs (PWID). A stronger understanding of how GPs can support this group in the uptake and completion of DAA treatment is required. METHOD: A purposive sample of 27 patients (nine women and 18 men) with a history of HCV participated in semi-structured interviews capturing perspectives about the role of GPs in facilitating and supporting DAA treatment. Thematic analysis focused specifically on experiences of accessing treatment while continuing injecting drug use and how GPs can support uptake in PWID. RESULTS: GPs need to prioritise and initiate discussions about HCV treatment with PWID. It is important that GPs provide clear and consistent information about the treatment journey; address myths of ineligibility and feelings of guilt and apathy towards treatment; and facilitate blood sampling, particularly for those with difficult venous access. DISCUSSION: This study contributes to HCV prevention and treatment literature by providing insights into practical ways GPs can encourage uptake and completion of treatment with PWID.

Personal, provider and system level barriers and enablers for hepatitis C treatment in the era of direct-acting antivirals: Experiences of patients who inject drugs accessing treatment in general practice settings in Australia.

Direct acting antiviral (DAA) treatment has made the elimination of hepatitis C virus (HCV) a realisable global public health goal and people who inject drugs are a key target population. This study investigates barriers and enablers to DAA treatment of HCV in general practice settings in Australia, from the patient perspective. Semi-structured interviews were conducted with 28 patients; of these patients, seventeen participants were currently on opioid agonist therapy, and four were currently injecting drugs. Thematic data analysis was undertaken and a personal, provider and systems framework was used to describe the barriers and enablers to DAA treatment. Results suggest a range of initiatives are required to support the uptake of DAA in general practice settings. These include the provision of formalised peer information and support, and increasing the accessibility of blood tests and liver assessment on-site. Further, there remains a need to address stigma and discrimination affecting people who inject drugs in community healthcare settings.

Prescribing direct-acting antivirals to treat hepatitis C virus in a general practice setting in Australia: 'so why not do it'?

BACKGROUND: The recent implementation of a scheme to provide universal access to direct-acting antiviral (DAA) medication to treat hepatitis C virus (HCV) places Australia in a unique position to reach global HCV elimination goals. To achieve this, increasing the uptake and success of DAA treatment in general practice settings is essential. AIMS: To explore current enablers and residual barriers to HCV treatment in general practice settings in the post-interferon era from both general practitioner (GP) and patient perspectives. METHODS: Semi-structured interviews with 11 GP and 27 patients were conducted to draw out both challenges and facilitators particularly relevant to DAA uptake and treatment journeys. RESULTS: Key enablers for successful treatment identified by this study included peer-led GP support and skill development, utilisation of electronic reminder systems, trusting relationships with patients and engaging with patients' social and family networks. Barriers related to accessible testing facilities and knowledge and confidence with DAA treatment continue to limit GP-led treatment. CONCLUSIONS: Despite a universal access scheme, barriers to DAA prescription in general practice settings remain. These include access to fibrosis testing and GP confidence in DAA prescription. Strengthening peer-led GP skill development and utilisation of electronic reminder systems may help GP prioritise HCV treatment. Access to fibrosis testing and pathology services with no out-of-pocket costs to patients, particularly in outer-metropolitan areas, should be urgently addressed.

Exploring Intimate Partner Violence in Polynesia: A Scoping Review.

Intimate partner violence (IPV) is a major, global public health concern with significant impacts, particularly for women, worldwide. There is an immediate need to develop comprehensive understandings of the complex drivers of this multifaceted issue in diverse cultural and social contexts. This scoping review used a systematic approach to gather a broad scope of peer-reviewed, publisher-controlled, and gray literature investigating IPV in Polynesia, a region of the Pacific experiencing high rates of IPV. A total of 181 articles were identified through a comprehensive search that included five cross-disciplinary databases; government, intergovernmental, and nongovernment websites; and consultation with community organizations. Thirty-three articles met the inclusion criteria related to IPV in a Polynesian country or community abroad and were included in this review. Narrative synthesis, which included summarizing and sorting key findings into common themes, was conducted to provide an overview of what is currently known about IPV in Polynesia and Polynesian communities living aboard. Key themes, which arose from the data analysis included: high prevalence of IPV, attitudes supporting IPV, urbanization and migration, traditional protective factors, and formal leadership and laws. The paucity of rigorous literature highlights an immediate need for IPV prevention research and intervention within Polynesian communities. This review includes a discussion of the limitations of this small body of literature and makes recommendations for future research, policy, and program development to include intersectionality in order to deepen understandings and enhance inclusive and meaningful intervention and policy implementation.

Using Applied Theater in Primary, Secondary, and Tertiary Prevention of Intimate Partner Violence: A Systematic Review.

There is an immediate need to advance knowledge around the effective prevention of intimate partner violence (IPV), which is responsible for significant negative health and well-being outcomes for women around the world. Creative approaches are being explored internationally-this systematic review provides a timely synthesis of applied theater interventions addressing primary, secondary, and tertiary IPV prevention. Six hundred and ten articles were identified through a comprehensive search of five cross-disciplinary databases. Eleven studies discussed in 15 quantitative and qualitative peer-reviewed articles and one book chapter met the inclusion criteria and were included in the review. Articles were appraised using a standardized quality assessment tool and were analyzed within the context of IPV prevention. Of the reviewed studies, five were classified as primary prevention, four secondary, and two focused on tertiary prevention. Specific strategies used by each of the studies included healthy relationship training, rising awareness and community advocacy, service provider training, bystander training, and working with survivors. While the paucity and quality of current literature make it difficult to determine overall efficacy, this review points to the potential of applied theater as a useful prevention strategy, particularly when interactive, participatory methods are incorporated. Further, applied theater could be an effective tool for working in culturally diverse settings as well as with minority groups. Future applied theater program planning needs to include comprehensive evaluation. More rigorous investigation, involving mixed-method research approaches, is required to fully understand the potential of applied theater as a tool in the context of IPV prevention.

How can HIV/STI testing services be more accessible and acceptable for gender and sexually diverse young people? A brief report exploring young people's perspectives in Queensland.

ISSUE ADDRESSED: Gender and sexually diverse young people (GSDYP) are an important target group for HIV/sexually transmitted infection (STI) prevention and there is an immediate need to explore ways to make testing interventions accessible and appropriate for this group. METHODS: We used a modified World Café workshop with 14 GSDYP in Brisbane Australia, to inform the development of a pilot community-based testing intervention. RESULTS: The workshop identified the key features of an ideal service, which would include multiple, accessible sites that offer holistic, affordable services and confidential care by respectful and knowledgeable providers. The service would allow young people to engage in decision-making processes, have a culturally inclusive, comfortable and friendly atmosphere, and provide free sexual and reproductive health technologies. CONCLUSION: When designing HIV/STI testing interventions for key groups, health promotion practitioners need to be cognisant of localised and nuanced expectations and ensure that services are tailored to the needs and experiences of the local population. SO WHAT?: This study provides insights into the needs and expectations of HIV/STI testing interventions for GSDYP in Australia, a key at-risk group whose perspectives are not adequately voiced in sexual health research and intervention design. SUMMARY: This study explores facilitators and current barriers to HIV/STI testing with a group of gender and sexually diverse young people in Brisbane, Australia. Outcomes provide insights into the needs and expectations of HIV/STI testing services for this group.

Applying intersectionality theory in health promotion research and practice.

Health promotion researchers and practitioners are grappling with how to address growing health inequalities for population groups. In particular, critiques of dominant behaviour change approaches draw attention to the need to engage with social theories to better understand the social and relational drivers of health. Public health researchers are increasingly acknowledging intersectionality as an important theoretical approach, providing a framework for investigating health inequalities by highlighting intersections of individuals' multiple identities within social systems of power that compound and exacerbate experiences of ill health. This article provides an overview of the diverse ways public health researchers and practitioners have applied intersectionality theory to better understand and address health inequalities. We map three key applications of intersectionality theory in public health: as an epistemological approach, as a methodological approach, and as a tool for action and intervention. Drawing on this work, we argue that health promotion researchers and practitioners can enhance engagement with intersectionality theory to address important challenges within the field. Through this article, we aim to inspire the continued exploration of intersectionality and offer some insights into opportunities and challenges for doing so in health promotion.

'In the Islands people don't really talk about this stuff, so you go through life on your own': An arts-based study exploring intimate relationships with young people in Samoa.

This study explores conceptualisations and understandings of intimate relationships with young people in Samoa - an at-risk group experiencing high rates of intimate partner violence and alienation from sexual and relationship health promotion. Insights contribute to the immediate need to advance knowledge and practice around prevention with this group. An arts-based approach, which included a two-day interactive drama workshop coupled with follow-up, peer-led focus groups, was used to explore perceptions and understandings related to intimate relationships with 15 tertiary educated young people (nine female and six male) from across Samoa. Intersectionality informed the data collection and thematic analysis, examining participants' lived experiences and the ways multiple and intersecting identities interact within social and cultural systems to influence and inform these experiences. Outcomes highlight important tensions for young people, including the way in which age, gender, religion and sexuality interact with social hierarchies and power structures, socially prescribed gender norms, family structures and globalisation. This research provides insights that can inform the development of prevention strategies to address the root causes of intimate partner violence, building the knowledge and skills required for establishing intimate relationships free from violence with young people.

Suiga/Change: An Ethnodrama Exploring Challenges in Intimate Relationships With Young People in Samoa.

Intimate partner violence (IPV) is a significant global issue and there is an immediate need to strengthen knowledge and support innovative action, particularly with young people and people in diverse cultural settings. This ethnodrama provides insights into the way young people in Samoa, a Pacific Island nation reporting high rates of IPV, experience and perceive IPV and challenges within intimate relationships. Suiga/Change is an authentic, emotive, and powerful story of four young people who represent the diversity and lived experiences of the wider population of young people in Samoa. Implications for future research and practice are discussed.

Culture X: addressing barriers to physical activity in Samoa.

There is an urgent need to address the epidemic rates of non-communicable diseases globally, and the Pacific Island region is of particular concern. Increasing physical activity participation plays an important role in reducing some of the key risk factors for non-communicable diseases including obesity and being overweight. In order to address low levels of physical activity, it is essential to understand the key barriers and facilitating factors experienced by specific population groups. The purpose of this study is to investigate key facilitating factors for participation in a dance aerobic initiative, Culture X, developed in the Pacific Island country, Samoa. The study further aims to understand ways in which the programme assists participants in addressing barriers to physical activity. Face-to-face interviews running from 10 to 20 min were conducted with 28 Culture X participants in order to gain a deep understanding of participants' personal perspectives with regard to barriers and facilitating factors to physical activity. Findings suggest the inclusion of key cultural components (including, traditional dance moves and music, prayer, community orientation and family inclusiveness) were integral for supporting ongoing participation in Culture X. These components further assisted participants in addressing important personal and social barriers to physical activity (including lack of motivation and enjoyment, lack of confidence, time management, family and social commitments and lack of support). This study highlights creative ways that health promotion in the Pacific Island region can encourage physical activity and informs health promotion literature regarding the importance of placing local culture at the heart of behaviour change initiatives.

Love Bugs: promoting sexual health among young people in Samoa.

ISSUES ADDRESSED: This project addressed the sexual health and well being of youth in Samoa; a key at-risk group experiencing high rates of sexually transmitted infections (STIs) and alienation from sexual health services. METHODS: Love Bugs included a health promotion event held at the National University of Samoa (NUS), exposing young people to sexual health information and developing personal skills and building self-efficacy around healthy relationships, communication and safer sex. A survey provided insights into participants' knowledge and perceptions of sexual health, STIs and healthy relationships. In response to survey results, six free condom dispensers were installed at NUS. RESULTS: Love Bugs exposed over 500 Samoan youth to positive sexual health information and provided an opportunity for personal skill development with regard to protecting sexual health and well being. Condom dispensers were developed and installed on the university campus for the ongoing access by students without concern of cost or embarrassment. Strong partnerships were built between key community and government stakeholders that encouraged collaborative action towards protecting sexual health and well being of Samoan youth. CONCLUSIONS: Love Bugs was a successful initiative which addressed sexual health and well being of young people in Samoa. A comprehensive evaluation should be undertaken. SO WHAT?: Love Bugs highlighted creative and culturally-appropriate ways to address sexual health in the Pacific. Rates of STIs and unplanned pregnancies, particularly for youth, could be reduced through investment in the implementation and evaluation of such initiatives.

Shakespeare in Prison: affecting health and wellbeing.

PURPOSE: This research aimed to investigate the impacts of the Queensland Shakespeare Ensemble Prison Project (QSEPP) on the health and wellbeing of participants, specifically with regard to social support. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted with prisoners participating in the project to gain insight into perceived sense of support within the QSEPP and across the prison context more broadly. FINDINGS: The QSEPP encouraged participants to foster a range of support networks through the development of relationships built on trust, respect and shared experiences. Participants also developed communication skills which may assist with establishing and maintaining supportive relationships inside and outside of prison. RESEARCH LIMITATIONS/IMPLICATIONS: This research highlights the inevitable challenges for researchers working within the prison context, including: correctional services' limitations, time and space restrictions and small sample sizes. This research offers some potentially innovative ways to combat such challenges. PRACTICAL IMPLICATIONS: The study highlights the potential of theatre-based interventions in the prison context and their role in fostering social support and enhancing wellbeing. SOCIAL IMPLICATIONS: The research explores the potential role theatre may play in improving the health and wellbeing of a disadvantaged and marginalised group, providing skills to enhance access to supportive networks inside and outside prison. ORIGINALITY/VALUE: To the best of our knowledge this is the first research of its kind and provides valuable insights into the role that theatre may play in fostering social support in the prison context.