Supermarket top-up of Healthy Start vouchers increases fruit and vegetable purchases in low-income households.

Stark, widening health and income inequalities in the United Kingdom underpin the need for increased support for low-income families to access affordable and nutritious foods. Using anonymised supermarket loyalty card transaction records, this study aimed to assess how an additional Healthy Start voucher (HSV) top-up of £2, redeemable only against fruit and vegetables (FVs), was associated with FV purchases among at-risk households. Transaction and redemption records from 150 loyalty card-holding households, living in northern England, who had engaged with the top-up scheme, were analysed to assess the potential overall population impact. Using a pre-post study design, 133 of these households' records from 2021 were compared with equivalent time periods in 2019 and 2020. Records were linked to product, customer and store data, permitting comparisons using Wilcoxon matched-pairs sign-ranked tests and relationships assessed with Spearman's Rho. These analyses demonstrated that 0.9 more portions of FV per day per household were purchased during the scheme compared to the 2019 baseline (p = 0.0017). The percentage of FV weight within total baskets also increased by 1.6 percentage points (p = 0.0242), although the proportional spend on FV did not change. During the scheme period, FV purchased was higher by 0.4 percentage points (p = 0.0012) and 1.6 percentage points (p = 0.0062) according to spend and weight, respectively, in top-up redeeming baskets compared to non-top-up redeeming baskets with at least one FV item and was associated with 5.5 more HSV 'Suggested' FV portions (p < 0.0001). The median weight of FV purchased increased from 41.83 kg in 2019 to 54.14 kg in 2021 (p = 0.0017). However, top-up vouchers were only redeemed on 9.1% of occasions where FV were purchased. In summary, this study provides novel data showing that safeguarding funds exclusively for FV can help to increase access to FV in low-income households. These results yield important insights to inform public policy aimed at levelling up health inequalities.

Emergency risk communication and sensemaking during smoke events: A survey of practitioners.

Emergency risk communication (ERC) for smoke emitted from major fires continues to challenge governments. During these events, practitioners (including scientific, communication, and emergency response government staff) are tasked with quickly making sense of the public health risks and the communication options available. Practitioners' sensemaking-the process of creating meaning from information about an unfolding emergency-is key to effective ERC. This article identifies the factors that ERC practitioners consider the most important to their sensemaking for smoke events. A survey of practitioners (n = 86) was conducted to elicit their views on the level of importance of 22 different factors (individual, organizational, and contextual) on their sensemaking. The results indicate that the majority of the factors tested are very important to practitioners. This finding likely reflects the multidimensional nature of emergency smoke events and provides evidence as to why practitioners are challenged when trying to make sense of emergency situations. Despite multiple factors being considered very important to practitioners, the time-limited nature of emergencies means that practitioners will inevitability be forced to prioritize in their sensemaking efforts. Our results also provide insight into practitioners' prioritization of different information sources. Specifically, practitioners prioritize their own knowledge and the knowledge of other practitioners. The two most important factors were information from other incident management stakeholders and the practitioners' past experience. Other information, including community-based and academic knowledge, appear to be of lower priority for practitioners. Based on the study results, recommendations for practice and future research are discussed.

Understanding predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries across the globe: A scoping review.

BACKGROUND: Pneumococcal disease causes substantial morbidity and mortality in older adults. Pneumococcal polysaccharide vaccine (PPV23) is routinely recommended to reduce the disease burden in this population. However, the vaccination coverage in older adults remains suboptimal in high-income countries. OBJECTIVES: We sought to understand the current landscape of published literature on the predictors of pneumococcal vaccine uptake in older adults aged 65 years and older in high-income countries, and to identify the gaps in literature to inform future research. METHODS: We conducted a scoping review employing the Arksey and O'Malley framework and Joanna Briggs Methods. We searched Medline, EMBASE, CINAHL, PsycInfo and Cochrane databases. We included quantitative and qualitative studies on predictors of pneumococcal vaccination in older adults that reported older adult- and pneumococcal vaccine-specific results, conducted in high-income settings, and published in English between January 2015 and April 2020. We excluded studies assessing interventions to improve vaccine uptake. We followed the Strategic Advisory Group of Experts on Immunization Working Group Vaccine Hesitancy Determinants Matrix to map the predictors within contextual, individual and social group, and vaccine and vaccination-specific influence determinants. Studies on providers and institutions were also included and results summarized separately. RESULTS: We included 52 publications in our review. Most of the predictors in 39 quantitative studies belonged to the individual and social group influences (n = 12), followed by contextual influences (n = 11) and vaccine and vaccination-specific issues (n = 3). Few qualitative studies explored the barriers to pneumococcal vaccination. Only five studies examined predictors from the healthcare providers' perspective. Three studies examined the institutional characteristics as the predictors of pneumococcal vaccination in older adults. CONCLUSIONS: We identified enablers and barriers of pneumococcal vaccination among older adults in high-income settings. We also identified gaps in the literature and provide recommendations for future research to address the gaps.

Unpacking the Realities and Complexities of Sensemaking: Government Practitioners' Experiences of Emergency Risk Communication.

During public health emergencies, government practitioners must rapidly make sense of the risk to human health and the emergency risk communication (ERC) options available. These practitioners determine what, how, and when information is communicated to the public. Recurring criticism of ERC indicates that the communication is not meeting the needs of the community. To improve ERC practice, it is therefore critical to understand practitioners' sensemaking in these complex and time-critical settings. This article unpacks the realities and complexities of sensemaking, the process by which practitioners create meaning from the information they receive about an emergency as it unfolds. Qualitative interviews gathered practitioners' lived experiences of public health emergencies, namely, smoke events (e.g., wildfires and industrial facility fires), and thematic analysis drew on sensemaking literature. The evidence shows that sensemaking is challenging, as practitioners experience pressure from the emergency context and organizational, political, and social expectations. Sensemaking for ERC comes with an underlying imperative to accurately make sense of the situation, in a timely manner and in a way that leads to the best health outcomes. Practitioners must balance creating plausible meaning (sensemaking) with the accuracy expected by stakeholders. The analysis also highlights how sensemaking scope is delimited by professional expert identities and roles within the emergency management system; that is, practitioners' understanding of their expertise and role, and that of other practitioners. Past lived experiences are viewed as key facilitators of both individual and collective sensemaking, and the history of similar public health events shapes sensemaking in this context.