The Collaborative Service Design Playbook to plan, design, and implement sustainable health services for impact.

This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up.

Using an integrated social cognition model to identify the determinants of QR code check-in compliance behaviors in the COVID-19 pandemic.

In Australia, checking in while entering venues was a legal requirement during the COVID-19 pandemic to track potential infection sites. This two-wave correlational study used an integrated theory of planned behavior model including moral norms, anticipated regret, and habit to predict check-in compliance in a sample of 181 Victorians (Mean Age = 41.88, 56.4% female) and 162 Queenslanders (Mean Age = 43.26, 47.5% female). Habit and intention predicted behavior, while perceived behavioral control did not. Intention was predicted by baseline habit, attitude, subjective norm, and moral norm in the Victorian sample, while only baseline habit and moral norm predicted intention in the Queensland sample. This study has potential implications for reviewing previous strategies and for future pandemic preparedness, both by identifying the drivers of infection control compliance, and through the discussion of how differences in effects between states may be linked to each state's experience of the pandemic (e.g. infection rates, lockdown length).

The OzHarvest Nourish Program: An evaluation of a hospitality-based program to support employment for young Australians.

Objectives: The youth unemployment rate in Australia is more than double the national average. Policies and programs to address barriers and improve youth engagement in education and employment are essential to achieve many of the United Nations' Sustainable Development Goals (SDGs). The aim of this mixed-methods study was to evaluate the OzHarvest Nourish Program, a free, hospitality-focused pathway to support employment and engagement for young people aged 16-25 years. Study design: Mixed-methods study. Methods: An online survey, workshop and semi-structured interviews with staff, volunteers, participants, and broader stakeholders were conducted using a qualitative, exploratory approach. Ethics approval was granted by the Griffith University Human Research Ethics Committee (#2022/492). Results: Five key themes were identified from interview data and a logic model was developed. Participants described significant benefits of participation, including improved food security, self-efficacy, and communication skills, reduced social isolation, and greater hope for the future. Conclusions: The Nourish Program is a transformative service that is improving wellbeing outcomes for program participants. Additional resourcing, including adequate funding, may be required to maximise program impact and support sustainability.

Health action process approach: promoting physical activity, and fruit and vegetable intake among Australian adults.

Based on the health action process approach (HAPA) this study examined whether changes in social cognition constructs could predict change in physical activity and fruit and vegetable intake for adult participants in My health for life, an Australian health promotion behaviour change program. Variance-based structural equation modelling was used to analyse data obtained from Australian adult program participants (n = 167) at baseline (T1), week 14 (T2), week 26 (T2), and 6-month post-program (T4). Change scores were calculated for the social cognition constructs and behaviour. Changes in action self-efficacy and outcome expectancies positively predicted changes in intentions. Action self-efficacy changes also predicted changes in maintenance self-efficacy which, in turn, mediated the effect of action self-efficacy on recovery self-efficacy and planning. Planning was predicted by changes in intentions and maintenance self-efficacy. Findings support the use of the HAPA model in designing complex health behaviour change interventions to achieve sustained behaviour change.

Why "mealtime chatter matters": A process evaluation of a preventive health brief intervention.

How parents communicate about food is important for building children's emotional relationships with food. "Mealtime Chatter Matters" (MCM) is an evidence-informed brief intervention providing behavioral strategies for parents focusing on positive communication at mealtimes. This process study explored parents' experiences of the brief intervention. Nine mothers participated in interviews, followed by a qualitative inductive analysis. Findings revealed the strengths and weaknesses of MCM and critical reflections of participants' experiences that can be used to inform future program strategies. This study has important health marketing implications for developing preventive health resources and indicates that future research on mealtime communication is warranted.

Disordered eating prevention: Co-designing a brief intervention for use in Community Child Health Services.

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses.

Examining the feasibility of a brief parent intervention designed to promote positive food communication with infants.

BACKGROUND: Few prevention interventions exist focusing on supporting parents to use positive food communication at mealtimes, for the prevention of disordered eating. "Mealtime chatter matters (MCM)" is a brief intervention designed for parents of infants. The intervention was designed in collaboration with child health nurses (CHNs) to be embedded into usual care. The overall aim of this study was to test the feasibility of the intervention through examining the acceptability of the MCM content and resources and the potential impact of the intervention on parents. METHODS: This pilot study utilised a mixed methods approach and took place within a regional child health service in Queensland, Australia (October 2021 to June 2022). Participants were parents of infants attending child health education groups and CHNs. The intervention consisted of a brief education session (including accompanying resources), facilitated by a Paediatric Dietitian. The acceptability of MCM content and resources was assessed by both parents and CHNs via self-reported questionnaires and the potential impact on parents assessed via pre-/post-self-reported questionnaires. RESULTS: Forty-six parents of infants (aged < 8 months) and six CHNs who hosted the intervention and observed the program's delivery participated in the study. MCM content and resources were highly acceptable to parents and CHNs, as both qualitative and quantitative data concurred. How the program may have potentially impacted parenting practices was unclear from the survey results and further investigation is required to better understand these. Tangible lessons and opportunities to further test this intervention were clear from current results. CONCLUSION: Overall, MCM was acceptable to both parents and CHNs, with the content and resources both being highly valued. Parents reported the content to be informative and engaging and CHNs were keen to have such an intervention available in the future. However, further modification and testing is required of MCM. This feasibility study is an essential first step in supporting parents and CHNs to access an evidence-based intervention with the aim of preventing disordered eating. TRIAL REGISTRATION: Griffith University Human Research Ethics Committee (2021/577) and Gold Coast Hospital and Health Service Human Research Ethics Committee (QGC/76618).

Community Organising Frameworks, Models, and Processes to Improve Health: A Systematic Scoping Review.

Community involvement engages, empowers, and mobilises people to achieve their shared goals by addressing structural inequalities in the social and built environment. Through this review, we summarised published information on models, frameworks, and/or processes of community organising used in the context of health initiatives or interventions and documented the outcomes following their use. A systematic scoping review was conducted in three databases with no restrictions on the date of publication, country, or written language. Out of 5044 studies, 38 met the inclusion criteria and were included in the review. The targeted health outcomes explored by the studies were diverse and included sub-domains such as the promotion of a healthy lifestyle, sexual and reproductive health, access to healthcare and equity, and substance abuse and chronic disease management. The outcomes of most initiatives or interventions were promising, with positive changes reported for the target populations. A wide variation was noted in the models, frameworks, or processes of community organising utilised in these studies. We concluded that variation implies that no single model, framework, or process seems to have predominance over others in implementing community organising as a vehicle of positive social change within the health domain. The review also highlighted the need for a more standardised approach to the implementation and evaluation of these initiatives. We recommend that it is essential to foster public and non-governmental sector partnerships to promote community-driven health promotion efforts for a more sustainable approach to these initiatives.

Creating an Implementation Enhancement Plan for a Digital Patient Fall Prevention Platform Using the CFIR-ERIC Approach: A Qualitative Study.

(1) Background: Inpatient falls are a major cause of hospital-acquired complications (HAC) and inpatient harm. Interventions to prevent falls exist, but it is unclear which are most effective and what implementation strategies best support their use. This study uses existing implementation theory to develop an implementation enhancement plan to improve the uptake of a digital fall prevention workflow. (2) Methods: A qualitative approach using focus groups/interview included 12 participants across four inpatient wards, from a newly built, 300-bed rural referral hospital. Interviews were coded to the Consolidated Framework for Implementation Research (CFIR) and then converted to barrier and enabler statements using consensus agreement. Barriers and enablers were mapped to the Expert Recommendations for Implementing Change (ERIC) tool to develop an implementation enhancement plan. (3) Results: The most prevalent CFIR enablers included: relative advantage (n = 12), access to knowledge and information (n = 11), leadership engagement (n = 9), patient needs and resources (n = 8), cosmopolitanism (n = 5), knowledge and beliefs about the intervention (n = 5), self-efficacy (n = 5) and formally appointed internal implementation leaders (n = 5). Commonly mentioned CFIR barriers included: access to knowledge and information (n = 11), available resources (n = 8), compatibility (n = 8), patient needs and resources (n = 8), design quality and packaging (n = 10), adaptability (n = 7) and executing (n = 7). After mapping the CFIR enablers and barriers to the ERIC tool, six clusters of interventions were revealed: train and educate stakeholders, utilize financial strategies, adapt and tailor to context, engage consumers, use evaluative and iterative strategies and develop stakeholder interrelations. (4) Conclusions: The enablers and barriers identified are similar to those described in the literature. Given there is close agreement between the ERIC consensus framework recommendations and the evidence, this approach will likely assist in enhancing the implementation of Rauland's Concentric Care fall prevention platform and other similar workflow technologies that have the potential to disrupt team and organisational routines. The results of this study will provide a blueprint to enhance implementation that will be tested for effectiveness at a later stage.

An Integrative Literature Review of Interventions to Protect People with Disabilities from Domestic and Family Violence.

PURPOSE: While domestic and family violence against people with disabilities is an ongoing and crucial public health concern, and awareness of the extent of violence against people with disabilities is growing, research on the field is still limited. Thus, the present review aims to systematically identify and synthesize evidence and effectiveness from intervention strategies to increase the awareness and skills of those with disabilities to reduce and prevent domestic and family violence against them. METHOD: PRISMA guidelines were followed to perform a systematic search of seven scientific databases to identify the peer-reviewed literature. RESULTS: A total of 17 eligible studies were identified (14 evaluations and 3 descriptive studies), with most taking place in developed countries. Children and women are the most frequent victims, and they were therefore the most common target audience of the included studies. Sexual, physical, and verbal abuse were the most reported types of abuse, while financial abuse and neglect were studied less often. Interventions also focused on a diversity of disabilities, including learning, intellectual, mental, and physical impairments. Overall, the intervention strategies reflected a substantial homogeneity: focus on training and education as well as setting up channels and facilities for victims to seek help. Nine studies yielded significant positive outcomes using various strategies and techniques, while five studies had mixed results, and three studies only reported on the intervention strategies but did not evaluate the results. CONCLUSIONS: This review confirms a significant gap in the literature on domestic and family violence against people with disabilities and how to prevent and address the violence through evidence-based interventions. Several recommendations to improve future research and practice are proposed.

Promoting adherence to stroke secondary prevention behaviours by imparting behaviour change skills: protocol for a single-arm pilot trial of Living Well After Stroke.

INTRODUCTION: Survivors of stroke have an elevated risk of recurrent stroke. Prompt intervention to support healthy lifestyle modification following an initial stroke is crucial for effective secondary prevention of stroke. However, many patients do not receive adequate postdischarge support for secondary prevention, particularly if not referred to inpatient rehabilitation. Living Well After Stroke is a health promotion programme based on the health action process approach (HAPA), which is designed to support this underserviced group to improve and self-manage secondary prevention behavioural performance (eg, diet, exercise, medication-adherence) by equipping participants with a toolkit of theory-based and evidence-based behaviour change strategies and techniques that are transferable to different behavioural contexts. METHODS AND ANALYSIS: The target sample is 118 adults living in Queensland, Australia, with stroke or transient ischaemic attack not referred to inpatient rehabilitation. Adopting a prospective single-arm trial design, the intervention comprises five behaviour change sessions over an 8-week period. Participants will receive a mix of individual-based and group-based assessments and interventions, based on the HAPA theoretical framework, delivered via telehealth or in-person (eg, public library). Measures of primary (ie, goal behaviours 1 and 2) and secondary outcomes (intention, outcome expectancy, risk perception, self-efficacy, planning, action control, subjective well-being) will be taken at 2 weeks, 4 weeks, 8 weeks and 16 weeks. The primary outcomes of the trial will be behavioural performance and transferability of behaviour change skills at 16 weeks. ETHICS AND DISSEMINATION: The study has received ethical approval from the Griffith University Human Research Ethics Committee (Ref no: 2022/308). Informed consent is obtained via telephone prior to data collection. Findings will be presented in the form of peer-reviewed journal articles, industry reports and conference presentations, and will be used to inform the continued development and refinement of the programme for testing in a future fully powered trial.

Multicomponent approaches to promoting healthy behaviours in people with Type 2 diabetes: an integrative review.

The progression of diabetes-related complications can be delayed with multifactorial interventions that support healthy behaviours. However, many initiatives have focused on educational or individual-level activities and observed limited or modest sustained improvements in healthy behaviours. A multicomponent approach to behaviour change, which simultaneously considers numerous social determinants of health across multiple socio-ecological model levels, may be required to achieve meaningful health outcomes for people with Type 2 diabetes. Applying a multicomponent method of inquiry, this integrative review aimed to synthesize the evidence on interventions using multifactorial interventions to promote healthy behaviours in adults with Type 2 diabetes. Interventions promoting healthy behaviours in adults with Type 2 diabetes were considered for the review. A total of 7205 abstracts retrieved from eight databases were screened for inclusion. Thirteen articles were included, of these 11 achieved statistically significant clinical and/or behavioural changes in outcomes such as glycated haemoglobin, blood pressure, cholesterol, diet and physical activity. The multifactorial components utilized included the coordination of multi-disciplinary health care teams, in-person self-care classes, group activities, incorporation of peer-leaders, the development of community partnerships, economic relief and built-environment support. The proportion of included studies published within recent years indicates a trend towards multicomponent interventions and the growing recognition of this approach in promoting public health. Our findings provide early support for the potential of extending intervention components beyond educational, individual-level and health care system-level focus to incorporate multiple socio-ecological model components that contribute to the system of influence affecting the health of people with diabetes.

Parental food communication and child eating behaviours: A systematic literature review.

AIM: To review current evidence for parental food communication practices and their association with child eating behaviours. METHODS: The PRISMA framework guided the reporting of the review; registered with Prospero in July 2020. Eligible studies were critically appraised using the Joanna Briggs Institute tools. Only quantitative studies that included a parental measure of food communication and a child measure of eating behaviour were included. RESULTS: From 11 063 articles 23 were eligible for synthesis. The vast majority (82%) of studies used observational cross-sectional designs. Three involved observing parent-child dyads, with the remainder using questionnaires. Two quasi-experimental designs tested interventions and two randomised control trial were reported. The majority of measures assessing parental food communication were subscales of larger questionnaires. The Caregiver's Feeding Style Questionnaire (CFSQ) was the most direct and relevant measure of parental food communication. Findings of reviewed studies highlighted that "how" parents communicate about food appears to impact child eating behaviours. Using child-centred communication provided promising outcomes for positive child eating behaviours, while parental "diet" communication was found to be associated with poorer dietary outcomes in children. CONCLUSIONS: Food communication research is in its infancy. However, evidence for the importance of parents' child-focused food communication is emerging, providing a focus for future research and interventions. SO WHAT?: Given the gaps in our understanding about prevention of disordered eating, there is a significant opportunity to explore what food communication strategies may assist parents to communicate about food in a positive way.

Using a Collective Impact framework to evaluate an Australian health alliance for improving health outcomes.

Complex social issues such as population health mean that no one person, organization or sector can resolve these problems alone and instead require a collaborative approach. This study applied the Collective Impact framework to evaluate the alliance responsible for delivering a large-scale health promotion initiative. Committee meeting minutes for a 4-year period and qualitative interviews with key stakeholders (N = 14) involved in the design and implementation of the initiative explored the factors that contributed to collaborative efforts and initiative outcomes. Major strengths of the Healthier Queensland Alliance (the Alliance) stemmed from identifying a common agenda and using frequent communication to develop trust among Alliance partners. These processes were important, particularly in improving key relationships to ensure inclusivity and equity. Reinforcing activities helped to support individual organizational efforts, while shared measurement systems promoted data-driven decision-making and learning, which contributed to continuous improvement and innovation. Current findings support the use of the Collective Impact framework as a scaffold to assist collaborative alliances in working effectively and efficiently when implementing large-scale initiatives aiming to create positive social impact. This study has identified the foundations of practice to establish a successful Collective Impact alliance.

Collective action to achieve social impact requires collaboration allowing organizations to expand their resources and abilities to enhance their collective capabilities. This paper reports on the use of the Collective Impact framework to show how a collaboration of partner organizations was developed to achieve social impact in a large health promotion initiative. The study identified six foundations for practice to enable successful collective partnerships that will be useful for practitioners and policy-makers when developing health promotion initiatives targeting a range of priority groups. The Collective Impact framework offers a strategic approach for building capacity in a range of communities to navigate power dynamics and find new ways of collaboration to achieve positive social impacts for their communities.

Effectiveness of interventions to improve health behaviours of health professionals: a systematic review.

OBJECTIVE: To evaluate the effectiveness of interventions designed to improve the health behaviours of health professionals. DESIGN: Systematic review. DATA SOURCES: Database searches: Medline, Cochrane library, Embase and CINAHL. REVIEW METHODS: This systematic review used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to compare randomised controlled trials of health professionals, published between 2010 and 2021, which aimed to improve at least one health behaviour such as physical activity, diet, smoking status, mental health and stress. Two independent reviewers screened articles, extracted data and assessed quality of studies and reporting. The quality of articles was assessed using the Effective Public Health Practice Project quality assessment tool and the completeness of intervention reporting was assessed. OUTCOME MEASURES: The outcome assessed was change in behaviour between intervention and control groups from baseline to follow-up. RESULTS: Nine studies met the eligibility criteria, totalling 1107 participants. Health behaviours targeted were mental health and stress, physical activity, and smoking cessation, physical activity and nutrition. Six interventions observed significant improvements in the health behaviour in the intervention compared with control groups. Seven of the studies selected in person workshops as the mode of intervention delivery. The quality of the included studies was high with 80% (7/9) graded as moderate or strong. CONCLUSIONS: Although high heterogeneity was found between interventions and outcomes, promising progress has occurred across a variety of health behaviours. Improving reporting and use of theories and models may improve effectiveness and evaluation of interventions. Further investigation is needed to recommend effective strategies. PROSPERO REGISTRATION NUMBER: CRD42021238684.

A Socio-Cognitive Review of Healthy Eating Programs in Australian Indigenous Communities.

PURPOSE: This paper aims to understand the challenges to healthy eating for Indigenous Australians using a Social Cognitive Theory lens. Understanding the environmental, cognitive, and behavioural barriers to healthy eating for Indigenous populations in Australia will help identify current gaps and highlight future actions needed in this area to close the gap for Indigenous Australians. STUDY DESIGN: Narrative review of interventions of healthy eating programs in Australian Indigenous communities sourced using a systematic search protocol to understand the environmental, cognitive, and behavioural barriers to healthy eating among Indigenous Australians and to identify gaps and future actions needed to address this from 2010-2020. RESULTS: The search produced 486 records, after duplicates were removed and the inclusion and exclusion process were utilised, seven interventions were retained in nine studies. The seven interventions had multiple study designs, from randomised control trials to case studies. CONCLUSIONS: Further work needs to explore the long-term feasibility of providing fruit and vegetable discounts and the impact of remoteness for the delivery of healthy food. Dietary interventions need to be clearly described, and fidelity and process of the design and implementation process to help with replication of work.

Changes in health behaviours in adults at-risk of chronic disease: primary outcomes from the My health for life program.

BACKGROUND: Chronic disease is the leading cause of premature death globally, and many of these deaths are preventable by modifying some key behavioural and metabolic risk factors. This study examines changes in health behaviours among men and women at risk of diabetes or cardiovascular disease (CVD) who participated in a 6-month lifestyle intervention called the My health for life program. METHODS: The My health for life program is a Queensland Government-funded multi-component program designed to reduce chronic disease risk factors amongst at-risk adults in Queensland, Australia. The intervention comprises six sessions over a 6-month period, delivered by a trained facilitator or telephone health coach. The analysis presented in this paper stems from 9,372 participants who participated in the program between July 2017 and December 2019. Primary outcomes included fruit and vegetable intake, consumption of sugar-sweetened drinks and take-away, alcohol consumption, tobacco smoking, and physical activity. Variables were summed to form a single Healthy Lifestyle Index (HLI) ranging from 0 to 13, with higher scores denoting healthier behaviours. Longitudinal associations between lifestyle indices, program characteristics and socio-demographic characteristics were assessed using Gaussian Generalized Estimating Equations (GEE) models with an identity link and robust standard errors. RESULTS: Improvements in HLI scores were noted between baseline (Md = 8.8; IQR = 7.0, 10.0) and 26-weeks (Md = 10.0; IQR = 9.0, 11.0) which corresponded with increases in fruit and vegetable consumption and decreases in takeaway frequency (p < .001 for all) but not risky alcohol intake. Modelling showed higher average HLI among those aged 45 or older (ß = 1.00, 95% CI = 0.90, 1.10, p < .001) with vocational educational qualifications (certificate/diploma: ß = 0.32, 95% CI = 0.14, 0.50, p < .001; bachelor/post-graduate degree ß = 0.79, 95% CI = 0.61, 0.98, p < .001) while being male, Aboriginal or Torres Strait Islander background, or not currently working conferred lower average HLI scores (p < .001 for all). CONCLUSIONS: While participants showed improvements in dietary indicators, changes in alcohol consumption and physical activity were less amenable to the program. Additional research is needed to help understand the multi-level barriers and facilitators of behaviour change in this context to further tailor the intervention for priority groups.