Promoting Child Health Equity through Health Literacy.

Every child has the right to a fulfilling and thriving life [...].

Health Literacy and Health-Related Quality of Life in Beijing Adolescents: A Path Analysis.

BACKGROUND: Health literacy is a critical driver of achieving an equitable world for every child and adolescent. Although the relationship between health literacy and health-related quality of life (HRQoL) has been documented, little is known among adolescents. In addition, due to lack of theory-driven empirical research, it remains unknown about the full relationship between health literacy, its antecedents, and HRQoL. OBJECTIVE: This study aimed to apply Manganello's framework to investigate how health literacy was associated with its antecedents and HRQoL in Beijing secondary students. METHODS: A cross-sectional study was conducted with 650 students in years 7 to 9 from four secondary schools in Beijing. Based on Manganello's health literacy framework, a self-administered questionnaire was used to collect information on health literacy, its antecedents (i.e., sociodemographics, self-efficacy, social support, school and community environment), and HRQoL. The 8-item Health Literacy Assessment Tool was used to measure health literacy (score range 0-37), and the KIDSCREEN-10 was used to measure HRQoL (score range 10-50). Path analysis was conducted to examine the mediating role of health literacy in the relationship between its antecedents and HRQoL. KEY RESULTS: Overall, the average score of students' health literacy and HRQoL was 26.37 (±5.89) and 37.49 (±5.78), respectively. Health literacy was positively correlated with HRQoL (r = 0.36, p < .01). In the final path model, health literacy was not associated with HRQoL. However, students' social support, school environment, and community environment were associated with HRQoL. Health literacy was affected by self-efficacy, social support, and school environment (all p < .05). CONCLUSIONS: A range of intrapersonal, interpersonal, and environmental factors were associated with health literacy and HRQoL. A holistic approach is needed to improve health literacy and HRQoL through multilevel intervention strategies such as increasing personal self-efficacy, promoting social support, and creating positive environments. [HLRP: Health Literacy Research and Practice. 2022;6(4):e300-e309.] Plain Language Summary: We investigated how health literacy was related to its influencing factors and HRQoL among Beijing secondary students in years 7 to 9. Health literacy and HRQoL were independent outcomes affected by a range of social-ecological factors including self-efficacy, social support, and perceptions of school and community environments.

A Health Equity Implementation Approach to Child Health Literacy Interventions.

Health and behavioural inequalities exist in all populations, including children. As a social determinant of health, health literacy is a crucial driver of equitable health outcomes in children. With the increasing calls for more actions on addressing low health literacy and inequalities, health literacy interventions to improve children's healthy behaviours have emerged as a key strategy to reduce health inequities. However, health literacy interventions face implementation challenges impacting upon potential outcomes, and disparities in the implementation of health literacy interventions also occur. Variation exists in child health literacy intervention target groups, timing, content and formats, and there is a lack of implementation specificity, resulting in a lack of clarity about which intervention strategies are the most effective in improving health literacy, related health behaviours, and associated health outcomes. While actions to facilitate child health intervention implementation exist, to minimise further perpetuation of child health inequities, this perspective calls for a health equity implementation approach to child health literacy interventions.

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children.

Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children's developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7-9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0-37), the six-item Newest Vital Sign (NVS, score range 0-6), and the 16-item Health Literacy Survey (HLS, score range 0-16). Based on Manganello's health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child's health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.

It takes a community to save a life in cardiac arrest: Heart safe community pilots, Australia.

ISSUE ADDRESSED: In Australia only 1 in 12 people will survive an out of hospital cardiac arrest (OHCA). Heart Safe Community (HSC) is a public health initiative being implemented by the Heart Foundation, Victoria in partnership with Ambulance Victoria. It aims to improve survival from OHCA by improving public access to 24 hours Automated External Defibrillators (AEDs) and by building local community skills and confidence in basic resuscitation. Over the period 2017-20, the University of Melbourne was commissioned to evaluate the implementation, effectiveness, and sustainability of three HSC pilots in Victoria, Australia. METHODS: Mixed methods were used including eight focus group discussions with 64 local HSC community stakeholders and local HSC pilot site evaluation data. RESULTS: The local HSC pilot community presentation surveys revealed that the HSC pilots delivered hundreds of presentations on bystander resuscitation, with 2772 local community members being exposed to the call to action: 'Call, Push Shock' and 'anyone can save a life'. Focus group discussions revealed that the HSC pilots built local community capacity to respond to OHCA as demonstrated by increased knowledge, confidence and skills to call Emergency Medical Services, attempt chest compression, acquire and use an AED. Community leadership to advocate for improved access to AEDs and to propagate HSC initiatives amongst community settings and cohorts has occurred. HSC implementation enablers and challenges exist. Community capacity-building frameworks can explain what makes the HSC pilot work. CONCLUSION: HSC can build local community capacity to respond to OHCA. Eight principles are suggested to support the building, implementation and sustainability of future HSC efforts. SO WHAT?: The HSC experience reveals that community members across the lifespan and multiple settings embrace opportunities to improve the safety and response in their community to a cardiac arrest when the action is simplified and community ownership cultivated.

Transforming UNICEF's approach to health system strengthening: what place can a blended learning course play?

BACKGROUND: The United Nations Children's Fund (UNICEF) published their Health Systems Strengthening (HSS) approach to meet its strategic goals of ending preventable maternal, newborn and child deaths and promoting the health and development of all children and reducing inequities in health in 2016. UNICEF commissioned the University of Melbourne's Nossal Institute for Global Health to develop and deliver a pilot blended HSS program, involving 60 hours of online learning and 2 weeks of face-to-face teaching over a 6-month period. To assess the extent to which the HSS program had built the first 83 UNICEF 2017 graduates' capabilities to apply HSS actions by 2017, UNICEF funded an independent evaluator from the University of Melbourne. METHODS: A mixed-methods assessment was conducted using: online surveys of graduates at: enrolment, completion, 6 months post-HSS program; nine focus groups with graduates at face-to-face workshops; and interviews with purposive samples of UNICEF graduates and graduate Senior Managers 12 months post-HSS program. RESULTS: The HSS program content, structure and mode of delivery was positively received. Graduates reported increased confidence taking HSS actions and multiple changes in work practices (e.g., increased systems thinking and using of health system-based approaches). Graduates' Senior Manager interviews revealed mixed impressions of graduates applying HSS actions, partly explained by the fit between the HSS program learnings and UNICEF's workplace environment. Key contextual factors influencing graduates applying HSS actions included: workload; limited opportunities to apply HSS actions; limited HSS examples; and variable support to apply HSS actions. Graduate and Senior Manager suggestions to optimise applying HSS actions included: linking HSS program content with UNICEF priorities; increasing opportunities for graduates to apply HSS actions; increasing access to HSS support. CONCLUSIONS: The paper concludes by presenting HSS program and assessment suggestions from the 2017 UNICEF Pilot HSS program assessment and actions taken for the 2018 UNICEF staff cohorts by HSS program developers, funders and beneficiaries.

Health Literacy: An Interactive Outcome Among Secondary Students in Beijing.

BACKGROUND: Health literacy enables a person to make good decisions regarding health care, disease prevention, and health promotion to maintain and improve health. Although health literacy research in China has gained increasing attention in recent years, most existing studies focus on adults rather than adolescents. In addition, little theory-driven empirical research has been conducted to fully understand the relationship among health literacy, its influencing factors, and health outcomes scored on a skills-based health literacy instrument. OBJECTIVE: This study applied Manganello's framework to investigate how health literacy was related to its antecedents and health status in secondary students in Beijing, China. METHODS: A cross-sectional study was conducted with 650 students in Years 7 to 9 (age 11-17 years) from four secondary schools. Students completed a self-administered questionnaire based on Manganello's health literacy framework, which measured key upstream determinants, including health literacy and self-report health status. Health literacy was measured on an 8-item skills-based instrument that assesses a person's ability to find, understand, appraise, and communicate health information in everyday life (scores range from 0-37). Descriptive statistics and path analysis were conducted to investigate the mediating role of health literacy in predicting health status. KEY RESULTS: Overall, the average scores of students' health literacy was 26.37 (±5.89). Manganello's framework was supported by the data collected (χ2/df = 2.049, p = .001, comparative fix index = 0.966, root mean square error of approximation = 0.041). Personal self-efficacy (r = 0.11, p = .007), social support (r = 0.18, p < .001), and school environment (r = 0.27, p < .001) predicted health literacy, which in turn predicted students' health status (r = 0.12, p = .005). CONCLUSIONS: Adolescent health literacy is not only a person's capability to protect health, but also an interactive outcome with the broader environment. Promoting health literacy could be a useful strategy to improve health status for adolescents; however, a holistic approach is needed to increase students' self-efficacy, promote social support, and create positive school environments to achieve optimal health literacy and health outcomes. [HLRP: Health Literacy Research and Practice. 2021;5(1):e1-e14.] PLAIN LANGUAGE SUMMARY: We investigated how health literacy was related to its influencing factors and health status among secondary students in Years 7 to 9 in Beijing, China. Students with low self-efficacy, low social support, and low perceptions of positive school environment were more likely to have low health literacy, which in turn predicted poor health status.

A pilot study of adolescent health literacy research in Melbourne: Implementation and reflections.

ISSUES ADDRESSED: While adolescent health literacy research has gained momentum, there is little evidence regarding its implementation and data collection in school settings. This study explored the feasibility of collecting health literacy data from Australian secondary schools and piloted three health literacy instruments. METHODS: A cross-sectional study was designed to recruit four government secondary schools in Melbourne. Active, opt-in consent was obtained from parents and students in Years 7-9, and an online survey was conducted. Three health literacy instruments were used: the 8-item Health Literacy Assessment Tool (HLAT-8), the Newest Vital Sign (NVS), and the 47-item Health Literacy Survey (HLS-47). RESULTS: A total of 120 students (age 12-15 years) were finally recruited from one school, whereas the other three schools declined due to busy educational commitment or no interest in research. Learnings and reflections on data collection included: a shared perspective of health literacy evaluation between school and researchers; the feasibility of online data collection; and the possibility of obtaining passive, opt-out consent. About one-quarter (23.7%-32.2%) of students were likely to have poor health literacy. CONCLUSIONS: Although the recruitment was challenging, this pilot study indicates the feasibility of large-scale online health literacy survey in future school-based research. SO WHAT?: Measuring and monitoring adolescent health literacy is essential to achieve the aim of the Australian Curriculum of Health and Physical Education. More implementation research is needed with representative samples to validate health literacy instruments and examine the impact of health literacy on health promotion outcomes in Australian adolescents.

Health Literacy and Its Mediating Role in Predicting Health Behaviors Among Chinese Secondary Students.

While health literacy research in mainland China has gained increasing attention, most studies focus on adults. This study aimed to examine the mediating role of health literacy in the relationship between a range of upstream factors and health behaviors among Chinese secondary students. A cross-sectional study was conducted with 650 students in Years 7 to 9 from four secondary schools in Beijing. Based on an adapted health literacy framework from Manganello, a self-administered questionnaire was designed to collect information on upstream factors, health literacy, and health behaviors. Path analysis results showed that the proposed framework was mostly supported by empirical data after modification indices were examined and 3 direct paths were added. Students' self-efficacy, social support, and school environment were associated with health literacy, which in turn predicted health behaviors. A holistic approach is needed to improve both adolescent health literacy and health behaviors for Chinese school-aged adolescents.

Public libraries as health literate multi-purpose workspaces for improving health literacy.

Now more than ever, in this COVID-19 pandemic, our individual and collective ability to access, understand and apply information to inform our health care and broader lifestyle decisions ie, to be health literate - has life or death consequences. This paper reflects upon the proposition of public libraries as health literate multi-purpose workspaces for improving health literacy. We draw upon our combined experiences as evaluators of organizational health literacy initiatives, and library sector development, engagement and advocacy. Key ideas were presented as part of the 2020 State Library Victoria seminar series on 'Libraries: The Heart of a Healthy Community'. Key messages included: Public libraries are well positioned to contribute to the health literacy movement, as they provide the general public with: universal free access to information and services; extensive in-house and outreach educational collaborative learning opportunities; and health and wellbeing support by being welcoming, safe, and trusted community spaces. To date, limited discussion exists about conceptualizing public libraries as health literate multi-purpose workspaces for supporting and sustaining public library health literacy efforts. A health literate organizational framework is suggested to support libraries simply supporting health information literacy to being recognised as health literate organizations. Five workspace principles (empowerment, equitable, inclusive, collaborative and integrated) are suggested to provide directions for public libraries as health literate multi-purpose workspaces for improving the health literacy of individuals, communities, organizations and indeed systems. To inform the design, implementation and evaluation of public libraries as workspaces for improving health literacy, key principles-focused evaluation questions are suggested for consideration. SO WHAT?: Public Libraries as welcoming, safe, and trusted community organizations are well placed to be health literate multipurpose workspaces for improving health literacy.

Adolescent Health Literacy in Beijing and Melbourne: A Cross-Cultural Comparison.

While adolescent health literacy has gained momentum, it is under-researched from a cross-cultural perspective. This study aims to compare health literacy among two cultural groups of secondary students in Beijing and Melbourne. A cross-sectional study was conducted with 770 students from five secondary schools in Beijing and Melbourne. A self-administered questionnaire was designed to collect information on health literacy (the eight-item health literacy assessment tool (HLAT-8), the Newest Vital Sign (NVS) and the 47-item Health Literacy Survey (HLS-47)), its antecedents and health outcomes. Overall, students' health literacy in Melbourne (n = 120) was higher than that in Beijing (n = 650): 28.25 ± 6.00 versus 26.37 ± 5.89 (HLAT-8); and 4.13 ± 1.73 versus 3.65 ± 1.64 (NVS). The proportion of students with low health literacy varied by instruments, representing 23.7-32.2% in Melbourne and 29.0%-45.5% in Beijing. In both cultural groups, students' self-efficacy, social support, and perceptions of school environment were associated with their health literacy, which in turn predicted their health behaviours, patient-provider communication and health status. Given the nature of our study design and small samples, a cautious conclusion would be that adolescent health literacy is sensitive to the broad cultural context and might be an interactive outcome influenced by an individual's health skills and the social environment. Particularly, creating a supportive school environment is critical to develop adolescent health literacy that would eventually contribute to better health outcomes.

Appropriateness of the Asylum Seeker Resource Centre-adapted Refugee Health Assessment Tool.

People seeking asylum (PSA) are recommended to undertake a comprehensive risk-based health assessment within 1 month of arrival in Australia. The Asylum Seeker Resource Centre (ASRC) offers health services to PSA in Victoria, through the ASRC nurse-led clinic. A healthcare assessment is conducted by nurses using a Refugee Health Assessment (RHA) tool. A process evaluation was conducted to assess if the adapted 2016 version of the RHA tool was able to appropriately identify, describe and prioritise the needs of PSA. Twelve ASRC nurses who conducted assessments were interviewed. All interviews were audio recorded, transcribed and analysed. The adapted RHA tool was considered as appropriate for identifying, describing and prioritising the needs of PSA. Three key interconnected themes emerged influencing the appropriateness of the tool: the tool; users' experiences; and the individual characteristics of the PSA undergoing the assessment. Key tool limitations included: the structure not being user-friendly; variability in users' sensitivity to using the tool; and the limited feedback from PSA on the adapted RHA tool. Given the high number of people seeking asylum in Australia and the complexity of their healthcare needs, this research provides preliminary guidance on ways to improve the appropriateness of the ASRC-adapted RHA tool.

"Sons of the West" leadership academy: Examining impact on community connectedness, leadership and self-efficacy.

ISSUE ADDRESSED: Australian men experience poorer health, have reduced help-seeking behaviours, engage in unhealthy coping mechanisms and suicide rates are disproportionately high, compared to Australian women. The "Sons of the West" (SOTW) Premiership Program is an Australian men's physical and mental health promotion program, which includes a Leadership Academy (LA), so that Premiership Program graduates can further develop skills and become leaders in improving male health. The aim of this research study was to determine if the SOTW Leadership Academy improved community connectedness, leadership attributes and self-efficacy amongst LA graduates. METHODS: Sixty-seven Australian males (M = 53.42, SD = 11.80, age range: 20-72), from two groups (Premiership Program graduates who completed the LA and those who only completed the Premiership Program) completed three self-rated questionnaires on community connectedness, self-efficacy and leadership qualities. RESULTS: There was a significant difference between the two groups, showing that LA graduates had increased levels of leadership skills, self-efficacy and community connectedness compared to those who did not complete the LA. CONCLUSION: This study indicates that a men's health program can not only engage and improve the health of men, but also help them develop skills and enhance their own strengths, so that they can improve the health and well-being of others. SO WHAT?: The development of leadership pathways and capacity building, embedded within health promotion programs, is an important aspect of improving health and well-being.

Workspace environmental design evaluation to support the aged care workforce: Are we using the right evaluation approaches?

OBJECTIVES: Australia's aged care workforce is facing pressures due to increased demands from an ageing population. This paper reflects upon whether existing workspace environmental design evaluations are supporting the aged care workforce. METHODS: This brief report was informed by a 2018 Optimising Aged Care Workspace Environment Symposium with three streams: (a) Developing, (b) Implementing and (c) Evaluating Aged Care Workspace Environments. RESULTS: Symposium key messages included the following: 'evidence (lived experiences and feedback) from both older people and the aged care workforce needs to inform both development and implementation of aged care environment design'. The Evaluating Aged Care Workspace Environments stream key messages included the following: 'evaluation approaches are required that are responsive and appropriate to the complex dynamic aged care workspace contexts'. CONCLUSION: To better inform the design of future aged care settings and support the aged care workforce, principles-focused evaluations of existing aged care settings with input from the aged care workforce are required.

Western Bulldogs Sons of the West Program ripple effects: building community capacity.

Professional sporting organisations can provide lifestyle-based community health improvement programs. Since 2014, the Western Bulldogs Australian Football League Club, through its Western Bulldogs Community Foundation (WBCF), has invested with community partners in the Sons of the West (SOTW) Program, a 10-week program targeted at hard-to-reach men aged ≥18 years living in Victoria's West. The SOTW Program aims to increase its participants' physical activity, social connectedness and overall health. Evaluations by the WBCF revealed the SOTW is positively contributing to improved healthier lifestyles and health of participants. Anecdotal reports revealed the SOTW was creating ripples far beyond the Program's expectations. In 2016-17, the WBCF funded the University of Melbourne to evaluate the SOTW Program ripple effects. An adapted 'Ripple Effect Mapping' approach was used, including 13 focus group discussions with 100 SOTW participants. The SOTW Program is improving men's social connections, health promoting behaviours, health literacy and creating ripple effects including: local community participation; increased volunteerism; enhanced reciprocity; and increased leadership. Community capacity-building frameworks can explain the SOTW Program ripple effects. Professional sporting organisations can provide lifestyle-based health improvement programs and empower men to contribute to building community capacity.

Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, <30% of people participate in a program. Significant patient, hospital and health system challenges exist to improve recovery through increased heart health literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels.

The Influence of Spatial Design on Team Communication in Hospital Emergency Departments.

OBJECTIVE: To identify spatial design factors that influence informal interprofessional team-based communication within hospital emergency departments (EDs). BACKGROUND: Effective team communication in EDs is critical for interprofessional collaborative care and prevention of serious errors due to miscommunication. Limited evidence exists about how informal communication in EDs is shaped by the physical workspace and how workplace design principles can improve the quality of ED team communication. METHOD: Two health services with four hospital sites in Victoria, Australia, participated. A multistage mixed-methods approach used (1) an anonymous online communication network survey ( N = 103) to collect data on patterns and locations of informal interprofessional team communication among ED staff, (2) focus groups ( N = 37) and interviews ( N = 3) using photoelicitation to understand the perspectives of ED staff about how spatial design influences team communication, and (3) validity testing of preliminary findings with executives and ED managers at the participating sites. RESULTS: Informal communication with peers and within discipline groups on nonspecific areas of the ED was most common. Three key factors influenced the extent to which ED workspaces facilitated informal communication: (1) staff perceptions of privacy, (2) staff perceptions of safety, and (3) staff perceptions of connectedness to ED activity. CONCLUSION: Our research supports the proposition that ED physical environments influence informal team communication patterns. To facilitate effective team communication, ED workspace spatial designs need to provide visibility and connectedness, support and capture "case talk," enable privacy for "comfort talk," and optimize proximity to patients without compromising safety.

Measuring functional, interactive and critical health literacy of Chinese secondary school students: reliable, valid and feasible?

Health literacy is an increasingly important topic in the global context. In mainland China, health literacy measures mainly focus on health knowledge and practices or on the functional domain for adolescents. However, little is known about interactive and critical domains. This study aimed to adopt a skills-based and three-domain (functional, interactive and critical) instrument to measure health literacy in Chinese adolescents and to examine the status and determinants of each domain. Using a systematic review, the eight-item Health Literacy Assessment Tool (HLAT-8) was selected and translated from English to Chinese (c-HLAT-8). Following the translation process, a cross-sectional study was conducted in four secondary schools in Beijing, China. A total of 650 students in Years 7-9 were recruited to complete a self-administered questionnaire that assessed socio-demographics, self-efficacy, social support, school environment, community environment and health literacy. Results showed that the c-HLAT-8 had satisfactory reliability (Cronbach's α = 0.79; intra-class correlation coefficient = 0.72) and strong validity (translation validity index (TVI) ≥0.95; χ2/ df = 3.388, p < 0.001; comparative fit index = 0.975, Tucker and Lewis's index of fit = 0.945, normed fit index = 0.965, root mean error of approximation = 0.061; scores on the c-HLAT-8 were moderately correlated with the Health Literacy Study-Taiwan, but weakly with the Newest Vital Sign). Chinese students had an average score of 26.37 (±5.89) for the c-HLAT-8. When the determinants of each domain of health literacy were examined, social support was the strongest predictor of interactive and critical health literacy. On the contrary, self-efficacy and school environment played more dominant roles in predicting functional health literacy. The c-HLAT-8 was demonstrated to be a reliable, valid and feasible instrument for measuring functional, interactive and critical health literacy among Chinese students. The current findings indicate that increasing self-efficacy, social support and creating supportive environments are important for promoting health literacy in secondary school settings in China.

Workplace design for the Australian residential aged care workforce.

OBJECTIVES: This research explored residential aged care (RAC) workplace design features that influence how RAC staff feel valued, productive, safe, like they belong and connected. A secondary aim was to validate emerging themes about RAC design features with stakeholders. METHODS: A multistage qualitative study was conducted in one RAC facility with 100 residents in outer metropolitan Melbourne: (i) photo-elicitation - photographs were used to prompt discussions with RAC staff; (ii) individual interviews with RAC directors; and (iii) validity testing with the advisory committee occurred. RESULTS: Key workplace design features that influenced how RAC staff feel valued, productive, safe, like they belong and connected included the following: (i) home-like environment; (ii) access to outdoor spaces; (iii) quality indoor environment; and (iv) access to safe, open and comfortable workplaces. CONCLUSIONS: Key workplace design features that matter to RAC staff in a 'shared workspace' exist. Increasing demands upon RAC requires evidence-based workplace design policy and evaluation approaches that support RAC staff to work in RAC shared workspaces.