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Although tobacco smoking in Australia is at a historical low, electronic cigarette (e-cigarette) use, especially among the youth is increasing. Policies around e-cigarette control in Australia are currently evolving, even during the pandemic, thus demonstrating its priority status. The current article discusses ethical issues for e-cigarette control policies in Australia using a public health ethics framework. The article is structured using the domains of the WHO-MPOWER framework of tobacco control to enable a comprehensive coverage of all elements of e-cigarette control policies in Australia. It highlights several ethical issues, from different stakeholder perspectives, and indicates moral and ethical tensions in different public health actions that might be considered in framing policies around e-cigarette control. Keywords: Electronic nicotine delivery systems, e-cigarettes, Australia,, smoke-free policy, public health ethics.

The Behrendt report (2012) highlighted the significant lack of representation of Aboriginal people in higher education. It called for a collaborative approach by governments, universities, and professional bodies to drive systemic changes. In the last decade, this has resulted in an increase of Aboriginal students, staff, and researchers. This article presents a qualitative research study in which Aboriginal social work academic participants described their experiences of curriculum changes, workload, and research in the academy. Implications for universities, and social work programs, in particular, show where more is needed in the form of antiracist action plans and follow-through with these to address failure to thrive due to having to fight to survive in the academy.

Despite the acknowledged injustice and widespread existence of parachute research studies conducted in low- or middle-income countries by researchers from institutions in high-income countries, there is currently no pragmatic guidance for how academic journals should evaluate manuscript submissions and challenge this practice. We assembled a multidisciplinary group of editors and researchers with expertise in international health research to develop this consensus statement. We reviewed relevant existing literature and held three workshops to present research data and holistically discuss the concept of equitable authorship and the role of academic journals in the context of international health research partnerships. We subsequently developed statements to guide prospective authors and journal editors as to how they should address this issue. We recommend that for manuscripts that report research conducted in low- or middle-income countries by collaborations including partners from one or more high-income countries, authors should submit accompanying structured reflexivity statements. We provide specific questions that these statements should address and suggest that journals should transparently publish reflexivity statements with accepted manuscripts. We also provide guidance to journal editors about how they should assess the structured statements when making decisions on whether to accept or reject submitted manuscripts. We urge journals across disciplines to adopt these recommendations to accelerate the changes needed to halt the practice of parachute research.

In Australia, the National Immunisation Program and its Standard Vaccination Schedule are administered by the Australian Government Department of Health. While the public vaccination program’s safety and worth are generally agreed upon by doctors and public health professionals, some continue to see vaccinations as a source of danger and harm. The burden of vaccination in order to receive public services aligns government and medical interests, but a less-than-trusting public may see conspiracy in such requirements, resulting in vaccine hesitancy. The media’s attention to the topic, and a tendency toward misinformation on the part of anti-government opinion leaders, necessitate additional exploration of the administrative burden of vaccinations in an increasingly complex policy environment, where public health benefits are weighed against individual freedom and belief. This paper examines vaccinations as a burden, with costs in compliance, learning, and psychological terms, using posts from the social networking site Twitter as a corpus for exploratory content analysis in the specific case of Australia and its requirements. It is worth considering whether the positive aspects messaged by public health professionals are successfully entering into the discourse on vaccinations.

Objective: Media framing of nutrition policy issues has been said to play a critical role in influencing public and political support for these issues. We examined the coverage of nutrition policy issues in the Australian news media to determine the key frames and expert sources used by the media. Methods: News articles published in Australia between 2008 and 2018 were retrieved from key media databases. Content analysis was used to identify nutrition policy issues reported and expert sources used. Frames were identified using a theoretical framework. Results: Seven nutrition policy categories were identified. Expert sources included representatives from public health, food industry and politicians. Six dominant frames were identified: government responsibility, industry responsibility, societal frame, individual responsibility, parental responsibility and nanny state frame. Nutrition experts tended to use thematic frames while government and food industry sources used episodic frames to deflect responsibility onto individuals. Conclusions: Despite high media representation of thematic frames and government responsibility in addressing nutrition policy issues, limited regulatory policy action has occurred in Australia. Implications for public health: Further research is needed to better understand different frames and their effectiveness in influencing public and political opinion. Greater coherence amongst health advocates would be beneficial to ensure a collective, recognised voice on issues.

Multi-site research studies are essential if we are to conduct national research across all Australian jurisdictions. There is widespread agreement among clinicians and researchers that obtaining essential approvals to conduct multi-site research studies in Australia can be complex, bureaucratic and time consuming. Although there is inherent value in the review process, resources and months of valuable research time are often expended long before the study has begun. Using our recent experience for a multi-site, longitudinal paediatric cohort study of children and adolescents who were detained in offshore immigration detention on Nauru, we describe the process of navigating the ethics and governance approval systems. We identify tips for researchers and clinicians conducting multi-site studies, including early consultation with ethics and governance committees, using their recommended templates, anticipating time delays, and commencing time consuming processes as early as permissible. Our recommendations at the systemic level include streamlined and integrated ethics and governance review processes for all Australian jurisdictions, with co-ordinated requests for further information, a standardised approach across all Research Governance Offices, a rapid system for addressing amendments and individualised study support and consultations. Above all, a nationally agreed framework whereby ethics and governance committees across jurisdictions communicate with each other, use the same electronic platform and present a unified process whilst protecting the welfare, rights, dignity and safety of research participants is required. The complexity of the current ethics and governance processes may inadvertently and unintentionally be a barrier to conducting ethical research.

The marked increase in transnational higher education third party arrangements in recent years represents globalizing forms of education. Third party arrangements involve a partner institution being approved to deliver the primary institution’s government-accredited courses. The primary institute is accountable for monitoring and documenting quality assurance and the third party is responsible to the primary institute for meeting the required higher education standards. This arrangement is particularly attractive for students who want to undertake an accredited degree from overseas, while retaining close relational, industry and cultural links in the home country. There has been some recent examination of higher education third parties focused on equity, transcultural pedagogy, and quality assurance. However, little research has been done regarding the Australian context. Alphacrucis College is one of the largest non-university, faith-based independent higher education institutes in Australia with three onshore third party arrangements in Sydney and Melbourne, as well as two offshore in Finland and the Philippines. Based on a case study including participant observation and a staff survey, this research argues that the success of faith-based third parties is largely a result of shared values and collaborative relationships. These are outworked in professional development and mentoring in learning and teaching, joint research and scholarship projects, equity of student experience through resourcing, and effective governance and quality assurance built on trust. While other higher education institutes may not have faith-based approaches, these findings can serve to produce successful onshore and offshore third parties in a broad range of contexts. Supplementary Information The online version contains supplementary material available at 10.1007/s11233-021-09077-1.

BackgroundLimited resources make prevention of complex population-level issues such as obesity increasingly challenging. Collaboration and partnerships between organisations operating in the same system can assist, however, there is a paucity of research into how relationships function at a local level. The aim of this study was to audit initiatives, explore networks, and identify potential opportunities for improving the obesity prevention system in a Health Service area of Western Australia (WA).MethodsA mixed-methods study was undertaken in a metropolitan Health Service in Perth, WA in 2019–20. Structured face-to-face interviews (n = 51) were conducted with organisations engaged in obesity prevention, to identify prevention initiatives and their characteristics using a Systems Inventory tool. The Research Team identified the 30 most active organisations during the Systems Inventory, and an online Organisational Network Survey was administered to explore: relationships across six domains; partnership duration; frequency of interaction with other organisations; barriers to implementation; and key contributions to obesity prevention. Descriptive statistics were used to summarise barriers, contributions and Systems Inventory data. Organisational Network Survey data were analysed using social network analysis through UCINET 6 for Windows and Netdraw software. Whole network and cohesion scores were calculated: average degree; density; diameter; and degree centralization. Core-periphery analysis was conducted to identify densely connected core and sparsely connected periphery organisations.ResultsThe Systems Inventory identified 189 unique prevention initiatives, mostly focusing on individual-level behaviour change. Fifty four percent (n = 15) of the Organisational Network Survey respondent organisations and most core organisations (67%,n = 8) were government. The information and knowledge sharing network had a density of 45% indicating a high level of information and knowledge exchange between organisations. The lowest densities were found within the receiving (3.3%), providing (5.5%) and sharing (5.6%) funding networks, suggesting that these formal relationships were the least established.ConclusionApplying a systems thinking lens to local obesity prevention revealed that initiatives conducted focused on individual-level behaviour change and that collaboration and communication between organisations focused on information sharing. Capturing the extent and nature of initiatives and the way partnerships operate to improve obesity prevention can help to identify opportunities to strengthen the networks.

In 2020, social workers across the world responded to the global COVID-19 pandemic and the consequent strict lockdown procedures over several months. In many countries, including Australia and New Zealand, this virtual shutdown period necessitated a reframing of social work practice to incorporate factors including delivery of services via virtual means and more limited access for vulnerable clients. This article draws on the integration of two methods designed to address the research question: ‘How has social work practice in Australia and New Zealand been affected by COVID-19?’ These include (i) a narrative review of papers published during 2020 on social work practice and the COVID-19 pandemic and (ii) an online survey, undertaken from October to December 2020, of Australian and New Zealand social workers. The questionnaire data were analysed using Statistical Package for the Social Sciences (SPSS) and thematic analysis. The findings of this article details include the significant impacts of COVID-19 on practice, the increased needs of clients, including a rise in health issues, violence, homelessness and financial concerns, and the resulting critical changes to social work workloads. Social workers also reported greater use of technologies to deliver services and fears for their families and themselves if exposed to COVID-19., This article examines how Australian and New Zealand social workers have adjusted to the COVID-19 pandemic. The article draws on a literature review of international social work papers published during 2020 and a survey of social workers in Australia and New Zealand to determine the impacts on social workers. We find there are similarities in responses noted by social workers across the world including the enhanced use of technologies, difficulties supporting vulnerable clients and personal impacts in both work and home environments. There are also differences brought about by Australian and New Zealand social workers’ prior experiences of disasters as well as issues with technology.

Background Engagement frameworks provide the conceptual structure for consumer engagement in healthcare decision making, but the level to which these frameworks support culturally and linguistically diverse (CALD) consumer engagement is not known. Objective This study aimed to investigate how consumer engagement is conceptualised and operationalized and to determine the implications of current consumer engagement frameworks for engagement with CALD consumers. Method Altheide's document analysis approach was used to guide a systematic search, selection and analytic process. Australian Government health department websites were searched for eligible publicly available engagement frameworks. A narrative synthesis was conducted. Results Eleven engagement frameworks published between 2007 and 2019 were identified and analysed. Only four frameworks discussed engagement with CALD consumers distinctly. Organisational prerequisites to enhance engagement opportunities and approaches to enable activities of engagement were highlighted to improve CALD consumers' active participation in decision making; however, these largely focused on language, with limited exploration of culturally sensitive services. Conclusion There is limited discussion of what culturally sensitive services look like and what resources are needed to enhance CALD consumer engagement in high‐level decision making. Health services and policy makers can enhance opportunities for engagement with CALD consumers by being flexible in their approach, implementing policies for reimbursement for participation and evaluating and adapting the activities of engagement in collaboration with CALD consumers. Patient/Public Contribution This study is part of a wider ‘CanEngage’ project, which includes a consumer investigator, and is supported by a consumer advisory group. The study was conceived with inputs from the consumer advisory group, which continued to meet regularly with the project team to discuss the methodology and emerging findings.

Partnering with consumers and patients and the community and public is a research and healthcare improvement imperative. Consumer and community involvement (CCI) requires behaviour change at the individual (researcher, health professional, manager), organisational (health service, university, medical research institute) and system level (funding policies, collaboration between organisations). To understand the barriers and enablers to meaningful CCI, a qualitative descriptive study was undertaken with researchers, health professionals, representatives from consumer organisations, and health services and ethics committees in Melbourne, Australia. Twenty-eight semi-structured interviews and one focus group were conducted in May-August 2019. Ethics approval was obtained. Thematic analysis was guided by the Capability, Opportunity and Motivation and Behaviour model (COM-B). Training of researchers and health professionals in CCI, benefits and systems and processes to undertake CCI, alongside incorporating CCI as a requirement for funding were identified as enablers. Lack of time and resources for CCI, challenges in finding consumers for projects and a perceived lack of evidence of the impact of CCI were barriers. These identified barriers and enablers will inform strategies to build the capacity of CCI at the individual, organisation and system level within the Australian Health Research Alliance.

Victoria was the Australian state most significantly affected by the COVID-19 pandemic in 2020, which caused significant disruption to Victorian health services. The aim of this case study is to describe the experience of the Victorian public health system in adapting to support allied health student education during the pandemic. Factors that affected student education were complex and dynamic, and included a decrease in traditional face-to-face learning opportunities due to a transition to telehealth, social distancing requirements, furlough of staff and travel restrictions. Impacts on placement capacity across allied health professions were highly variable. Strategies used to enable the continuation of student work-integrated learning (WIL) (also referred to as clinical placements or fieldwork) included an increase in remote placements and the use of technology. Enhanced communication between government and health service educators enabled rapid sharing of information and problem solving. At this time, the impacts on student preparedness for practice are unclear but may include deficits in interprofessional learning, clinical skills, increased levels of agility and enhanced resilience. This case study highlights the need for the health system to be adaptable and innovative to maintain the quality of student education, and the future allied health workforce, through the pandemic and beyond. What is known about the topic? The COVID-19 pandemic caused significant disruption to Victorian health services and consequently their ability to support WIL for students during this time. The pandemic created risks for continuity of student learning and future allied health workforce supply. What does this paper add? The challenges that Victorian public health services faced to support student education during the pandemic were complex and dynamic. This paper describes the ways in which health services adapted to optimise the capacity and quality of student education. What are the implications for practitioners? This case study highlights that a focus on student well-being and a high level of problem solving for health services were required to support student learning during the pandemic, and that enhanced communication between government and health services supported the rapid sharing of innovations. These strategies can be used to support quality student WIL through the pandemic and beyond.

Demographic change, improvements in medical screening and treatment, evolving patterns of work, and eroding social security systems are contributing to greater numbers of seriously and chronically ill employees within the workforce. This study builds upon research in Corporate Social Responsibility and return to work (RTW) to conceptualize responsible return to work (RRTW). The study draws upon first-hand accounts of Australian women breast cancer survivors to inductively theorize the factors influencing RRTW practices. RTW practices that accommodate illness as required by law and regulation are found to be insufficient to meet employees’ needs and expectations and significant challenges for RTW are caused by this frame of reference and the distinction between medically certificated and non-medically certificated leave. Interactions between the economic case for creating mutual benefit through cooperation between employer and employee and the moral case for on-going tailored workplace adaptations as part of RRTW are critically evaluated.

Background The rollout of vaccines against COVID-19 is prompting governments and the private sector to adopt mandates. However, there has been little conceptual analysis of the types of mandates available, nor empirical analysis of how the public thinks about different mandates and why. Our conceptual study examines available instruments, how they have been implemented pre-COVID, and their use for COVID-19 globally. Then, our qualitative study reports the acceptability of such measures in Western Australia, which has experienced very limited community transmission, posing an interesting scenario for vaccine acceptance and acceptability of measures to enforce it. Method Our conceptual study developed categories of mandates from extant work, news reports, and legislative interventions globally. Then, our empirical study asked 44 West Australians about their attitudes towards potential mandatory policies, with data analysed using NVivo 12. Results Our novel studies contribute richness and depth to emerging literature on the types and varying acceptability of vaccine requirements. Participants demonstrated tensions and confusion about whether instruments were incentives or punishments, and many supported strong consequences for non-vaccination even if they ostensibly opposed mandates. Those attached to restrictions for disease prevention were most popular. There were similar degrees of support for mandates imposed by employers or businesses, with participants showing little concern for potential issues of accountability linked to public health decisions delegated to the private sector. Participants mostly supported tightly regulated medical exemptions granted by specialists, with little interest in religious or personal belief exemptions. Conclusion Our participants are used to being governed by vaccine mandates, and now by rigorous lockdown and travel restrictions that have ensured limited local COVID-19 disease and transmission. These factors appear influential in their general openness to COVID-19 vaccine mandates, especially when linked explicitly to the prevention of disease in high-risk settings.

Objective: Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016–2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. Design: A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. Setting: Australia. Participants: Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. Results: The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. Conclusions: Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

The COVID-19 global pandemic has disrupted research and restricted travel, threatening valuable research opportunities for early-career researchers. Support networks are critical to help overcome the challenges of relocation during this time.

Introduction: Consistent with the aspirations of First Nations Australians for community control of healthcare services, 123/196 (63%) of Australia's First Nations-specific primary health care services are community-controlled. Yet despite policy commitment over 30 years, the transition of government-run First Nations' primary healthcare services to First Nations community control has been slow. This paper identifies the barriers and enablers to transitioning the delivery of primary healthcare services from Queensland Health to Gurriny Yealamucka community-controlled health service in Yarrabah.Methods: Grounded theory methods were used to select 14 Gurriny and Queensland Health (QH) personnel involved in the transition for interview and to analyse these interview transcripts and 88 Gurriny organisational documents.Results: Barriers and enablers to transition were identified at three levels: those internal factors within Gurriny, external factors directly related to the government handover, and broader structural and policy factors outside the control of either Gurriny or QH. Barriers at the Gurriny organisational level were an internal lack of experience and capacity, and varying levels of community confidence; enablers were leadership stability and capacity, community mandate, relationships with partner organisations, and ability to provide service continuity. Barriers in Gurriny's relationship with QH were a lack of certainty, transparency and prioritisation of the transition process; systemic racism; difficulties obtaining and maintaining the necessary workforce; limited resources including insufficient, unstable and inappropriate funding support; and problems with information sharing; enablers were performance frameworks to keep transition progress on track. Barriers in broad policy environment were an unsupportive Queensland government policy environment; government bureaucracy; and delays, conflicts and divisions; enablers were high-level government support and commitment.Conclusions: The evaluation of Yarrabah's transition process suggests that future such transitions will require planning and commitment to a long-term, multi-faceted and complex process, encompassing the required level of authorisation and resourcing. This case example of a transition from government to community control of PHC highlighted the ongoing power issues that are faced every day by community-controlled organisations that co-exist with mainstream health systems within a colonial power structure.

Summary Investigating and exposing tobacco industry tactics to oppose and interfere with tobacco control policymaking is crucial to advancing public health. Whilst past investigations of tobacco industry activities have largely focused on secondary sources of information, such as publicly available tobacco industry documents, the collection of first-hand evidence from key informants has been an under-utilized method in tobacco industry monitoring. This article provides a detailed account of a methodological approach to systematically recruit former tobacco company employees as key informants for a study that aimed to gather information on the marketing tactics tobacco companies use in the Australian retail channel. Given the success of our study methodology in uncovering new information about tobacco company practices, we propose that key informant interviews with former industry employees should be a priority method for research investigating the role of commercial actors in influencing public health outcomes. To offer guidance to researchers who may wish to undertake a similar methodological approach, we also provide a reflective account of the elements of success and the lessons learned from this research.

Mental health issues are a severe global concern with significant personal, social, and economic consequences and costs. This paper reports results of an online survey disseminated across the Australian community investigating why people with mental health issues choose particular mental health services over others, what causes them to disengage from services, and what factors and qualities of services are important to consumers to support their continued engagement or re-engagement with mental health services. The importance of GPs was evident, given their key role in providing mental healthcare, especially to those referred to as “the missing middle”—consumers with mental health issues who fall through the gaps in care in other parts of the healthcare system. The study found that many respondents chose to engage with mental healthcare providers primarily due to accessibility and affordability, but also because of the relational qualities that they displayed as part of delivering care. These qualities fostered consumers’ sense of trust, feeling listened to, and not being stigmatized as part of help seeking and having their mental health needs met. Implications for education and practice are offered.

Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia’s Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Study (IDES): a two-wave survey of 197 DES participants that aims to understand their perspectives on factors that influence access to paid work. Analysis of employment status by type of barrier indicates many respondents experience multiple barriers across vocational (lack of qualifications), non-vocational (inaccessible transport) and structural (limited availability of jobs, insufficient resourcing) domains. The odds of gaining work decreased as the number of barriers across all domains increased with each unit of barrier reported (OR 1.22, 95% CI 1.07, 1.38). Unemployed respondents wanted more support from employment programs to navigate the welfare system and suggest suitable work, whereas employed respondents wanted support to maintain work, indicating the need to better tailor service provision according to the needs of job-seekers. Combined with our findings from the participant perspective, improving understanding of these relationships through in-depth analysis and reporting of DES program data would provide better evidence to support current DES reform and improve models of service delivery.

Aim: In the crowded field of leadership research, Indigenous leadership remains under-researched. This article explores the Leadership Model of an Aboriginal Community Controlled Primary Health Care Organisation providing services to the Yolngu people of remote northern Australia: the Miwatj Health Aboriginal Corporation (Miwatj). Background: The limited research which does exist on Indigenous leadership points to unique challenges for Indigenous leaders. These challenges relate to fostering self-determination in their communities, managing significant community expectations, and navigating a path between culturally divergent approaches to management and leadership. Methods: Guided by Indigenous methodology and using a mixed methods approach, semi-structured interviews, self-reported health service data, organisational and publicly available documents, and literature were analysed using a framework method of thematic analysis to identify key themes of the Miwatj Leadership Model. Findings: The Miwatj Leadership Model is underpinned by three distinctive elements: it offers Yolngu people employment opportunities; it supports staff who want to move into leadership positions and provides capacity building through certificates and diplomas; and it provides for the physical, emotional, and cultural wellbeing of all Yolngu staff. Furthermore, the model respects traditional Yolngu forms of authority and empowers the community to develop, manage and sustain their own health. The Miwatj Leadership Model has been successful in providing formal pathways to support Indigenous staff to take on leadership roles, and has improved the accessibility and acceptability of health care services as a result of Yolngu employment and improved cultural safety. Conclusions: Translating the Miwatj Leadership Model into other health services will require considerable thought and commitment. The Miwatj Leadership Model can be adapted to meet the needs of other health care services in consideration of the unique context within which they operate. This study has demonstrated the importance of having a formal leadership model that promotes recruitment, retention, and career progression for Indigenous staff.

The Australian Institute of Health and Welfare (AIHW) has been providing support to the Australian Government Department of Health to report on mental health-related data to Australian governments on a frequent basis since April 2020 in the form of COVID-19 mental health services data dashboards. These dashboards feature extensive use of data visualizations which illustrate the change in mental health service use over time as well as comparisons with pre-pandemic levels of service use. Data are included from the Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS/RPBS), Australian Government-funded crisis and support organizations, and key findings from emerging research. Demand for telehealth, crisis and support organizations and online mental health information services, in particular, have increased during the pandemic. The dashboards incorporate both new and existing data sources and represent an innovative way of reporting mental health services data to Australian governments. The reporting has enabled timely, targeted adjustments to mental health service delivery during the pandemic with improved cooperative data sharing arrangements having the potential to yield ongoing benefits.

Automatic facial recognition technology (AFR) is increasingly used in criminal justice systems around the world, yet to date there has not been an international survey of public attitudes toward its use. In Study 1, we ran focus groups in the UK, Australia and China (countries at different stages of adopting AFR) and in Study 2 we collected data from over 3,000 participants in the UK, Australia and the USA using a questionnaire investigating attitudes towards AFR use in criminal justice systems. Our results showed that although overall participants were aligned in their attitudes and reasoning behind them, there were some key differences across countries. People in the USA were more accepting of tracking citizens, more accepting of private companies’ use of AFR, and less trusting of the police using AFR than people in the UK and Australia. Our results showed that support for the use of AFR depends greatly on what the technology is used for and who it is used by. We recommend vendors and users do more to explain AFR use, including details around accuracy and data protection. We also recommend that governments should set legal boundaries around the use of AFR in investigative and criminal justice settings.

Background The use of government health data for secondary purposes, such as monitoring the quality of hospital services, researching the health needs of populations, and testing how well new treatments work, is increasing. This increase in the secondary uses of health data has led to increased interest in what the public thinks about data sharing, in particular, the possibilities of sharing with the private sector for research and development. Although international evidence demonstrates broad public support for the secondary use of health data, this support does not extend to sharing health data with the private sector. If governments intend to share health data with the private sector, knowing what the public thinks will be important. This paper reports a national survey to explore public attitudes in Australia toward sharing health data with private companies for research on and development of therapeutic drugs and medical devices. Objective This study aims to explore public attitudes in Australia toward sharing government health data with the private sector. Methods A web-based survey tool was developed to assess attitudes about sharing government health data with the private sector. A market research company was employed to administer the web-based survey in June 2019. Results The survey was completed by 2537 individuals residing in Australia. Between 51.8% and 57.98% of all participants were willing to share their data, with slightly fewer in favor of sharing to improve health services (51.99%) and a slightly higher proportion in favor of sharing for research and development (57.98%). There was a preference for opt-in consent (53.44%) and broad support for placing conditions on sharing health information with private companies (62% to 91.99%). Wide variability was also observed in participants’ views about the extent to which the private sector could be trusted and how well they would behave if entrusted with people’s health information. In their qualitative responses, the participants noted concerns about private sector corporate interests, corruption, and profit making and expressed doubt about the Australian government’s capacity to manage data sharing safely. The percentages presented are adjusted against the Australian population. Conclusions This nationally representative survey provides preliminary evidence that Australians are uncertain about sharing their health data with the private sector. Although just over half of all the respondents supported sharing health data with the private sector, there was also strong support for strict conditions on sharing data and for opt-in consent and significant concerns about how well the private sector would manage government health data. Addressing public concern about sharing government health data with the private sector will require more and better engagement to build community understanding about how agencies can collect, share, protect, and use their personal data.

BACKGROUND: Telehealth has seen rapid but unregulated growth in Australia during the COVID-19 pandemic, facilitated by the interim establishment of a universal Medicare Benefits Schedule item for telehealth consultations. Consumers and healthcare providers, including many general practitioners, have turned to telehealth with enthusiasm. OBJECTIVE: The aim of this article is to present evidence and analysis supporting the adoption of national telehealth standards in Australia. DISCUSSION: Despite efforts by professional organisations to develop telehealth standards, Australia lacks a national telehealth strategy and a unified set of shared standards for clinical governance and quality assurance that can be applied across the health system. To ensure consumer safety and support healthcare providers in telehealth, a national regulatory framework and telehealth standards should be established on the basis of the latest evidence on safety and quality in all forms of telehealth.

Background For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as ‘Grey Nomads’. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the ‘baby boomer’ generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946–1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may “burden” already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. Methods The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. Results These nursing managers described a strong service and community ethos. They regarded travellers’ healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. Conclusion Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia’s national transition to electronic health records including a patient—held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs.

PURPOSE OF REVIEW: As evidence continues to emerge of the harms associated with nonmedical androgen use, this review explores the implications from recent studies for designing strategies to reduce harm and support good health amongst androgen users.RECENT FINDINGS: Studies have predominantly come from researchers in the UK and Australia. Major themes include questioning the scope and content of harm reduction strategies and identifying approaches to improve engagement between the androgen using community and healthcare providers. Findings suggest that a broader range of interventions and forms of advice are needed than are commonly provided. This must be supported by efforts to increase opportunities to deliver harm reduction through new engagement approaches, better relationships with health professionals and more guidance on identifying and managing associated adverse health impacts.SUMMARY: A fully developed harm reduction-based response to nonmedical androgen use will be one that not only seeks to reduce risk of bloodborne virus transmission and injecting-related harms, but that considers the range of needs amongst the diverse community of androgen users and respects their decisions and rights. Co-producing interventions with members of this community will help develop effective and engaging approaches. Rigorous studies are needed to evaluate new harm reduction interventions as well as those already delivered.

Aims Suicide prevention remains a priority in rural and remote Australia, where suicide rates continue to be higher than those in urban communities. This commentary describes the Good SPACE suicide prevention program, and the lessons learned from delivering this program over a 14-year period. Context The Good SPACE program has been operating in rural New South Wales since 2007. The program focuses on educating rural community members to recognise the signs of suicide vulnerability, and how to take appropriate action if they encounter someone considering suicide. Approach Communities are selected to receive Good SPACE training in consultation with key stakeholder organisations, or by request from communities. Across the life of the program, key challenges in its administration have included short-term funding arrangements and staff turnover. Strengths have included the ability to adapt content to meet the needs of rural communities (eg from an initial focus on helping farmers during periods of drought, to a broader focus on all rural residents and a wider range of adversities). As the program moves forward, emphasis will be placed on harder-to-reach populations, including males and those with lower mental health literacy. Conclusion The Good SPACE program has ongoing funding to adapt its content and continue administration through the Rural Adversity Mental Health Program (https://www.ramhp.com.au/). The lessons learned throughout the life of the program might be of use to other organisations aiming to provide community-based education programs in rural and remote communities.

Background Engagement of people with lived experience and members of the public is an ethically and scientifically essential component of health research. Authentic engagement means they are involved as full partners in research projects. Yet engagement as partnership is uncommon in practice, especially during priority-setting for research projects. What is needed for agenda-setting to be shared by researchers and people with lived experience and/or members of the public (or organisations representing them)? At present, little ethical guidance exists on this matter, particularly that which has been informed by the perspectives of people with lived experience and members of the public. This article provides initial evidence about what they think are essential foundations and barriers to shared decision-making in health research priority-setting and health research more broadly. Methods An exploratory, qualitative study was conducted in 2019. 22 semi-structured interviews were performed with key informants from the UK and Australia. Results Three main types of foundations were thought to be essential to have in place before shared decision-making can occur in health research priority-setting: relational, environmental, and personal. Collectively, the three types of foundations addressed many (but not all) of the barriers to power sharing identified by interviewees. Conclusions Based on study findings, suggestions are made for what researchers, engagement practitioners, research institutions, and funders should do in their policy and practice to support meaningful engagement. Finally, key international research ethics guidelines on community engagement are considered in light of study findings.

Summary Citizen science connects academic researchers with the public through combined efforts in scientific inquiry. The importance of involving impacted populations in health research is well established. However, how to achieve meaningful participation and the methodological impact of citizen science needs further examination. We examined the feasibility of using citizen science to understand the impact of alcohol advertising on Australian women through a breast cancer prevention project. Two hundred and eighty-two (‘participants’) citizen scientists completed demographic and behavioural questions via an online survey. The research participants moved into the role of citizen scientists by completing the data collection tasks of capturing and classifying images of alcohol advertising they saw online. Interrater reliability tests found high levels of agreement between citizen scientists and academic researchers with the classification of alcohol advertising brand (Kappa = 0.964, p

The COVID-19 pandemic has intensified existing workplace stresses and created new challenges for people working on the healthcare frontline, including rapid workplace changes and increasing uncertainty at work, along with fear of contracting the virus. The purpose of this study is to examine the workplace challenges described by Australian frontline health workers during the pandemic. Drawing on a national online anonymous survey of 9518 healthcare workers, we analysed free-text responses to the question: “What did you find to be the main challenges that you faced during the pandemic?” A qualitative content analysis was undertaken. We identified five key themes relating to participant experiences of workplace challenges. These were: Work-life imbalance, Following orders or caring for patients, Unpredictability, disruption, and inconsistency at work, The right to be safe at work, and (Un)preparedness in the workplace. We argue that working during the COVID-19 pandemic illuminated existing occupational health and safety issues that have serious implications for job satisfaction, health workforce retention, and ultimately, patient care.

This paper describes the first six years of a government-initiated project to train Indigenous health professionals in digital mental health (d-MH). It illustrates how community-based participatory research (CBPR) methods were used to enable this “top-down” project to be transformed into a ‘ground-up’ community-guided process, and how, in turn, the guidance from the local Indigenous community partners went on to influence the national government’s d-MH agenda. The CBPR partnership between five community partners and a university rural health department is described, with illustrations of how CBPR harnessed the community’s voice in making the project relevant to their wellbeing needs. The local Indigenous community’s involvement led to a number of unexpected outcomes, which impacted locally and nationally. At an early stage, the conceptual framework of the project was changed from d-MH to the culturally-relevant Indigenous framework of digital social and emotional wellbeing (d-SEWB). This led to a significant expansion of the range and type of digital resources, and to other notable outcomes such as successful advocacy for an Aboriginal-specific online therapy program and for a dedicated “one-stop-shop” d-SEWB website, Wellmob, which was funded by the Australian government in 2019–2021. Some of the implications of this project for future Indigenous CBPR projects are discussed.

When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress, however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.

Despite significant developments in Aboriginal and Torres Strait Islander Health information over the last 25 years, many challenges remain. There are still uncertainties about the accuracy of estimates of the summary measure of life expectancy, and methods to estimate changes in life expectancy over time are unreliable because of changing patterns of identification. Far too little use is made of the wealth of information that is available, and formal systems for systematically using that information are often vestigial to non-existent. Available information has focussed largely on traditional biomedical topics and too little on access to, expenditure on, and availability of services required to improve health outcomes, and on the underpinning issues of social and emotional wellbeing. It is of concern that statistical artefacts may have been misrepresented as indicating real progress in key health indices. Challenges and opportunities for the future include improving the accuracy of estimation of life expectancy, provision of community level data, information on the availability and effectiveness of health services, measurement of the underpinning issues of racism, culture and social and emotional wellbeing (SEWB), enhancing the interoperability of data systems, and capacity building and mechanisms for Indigenous data governance. There is little point in having information unless it is used, and formal mechanisms for making full use of information in a proper policy/planning cycle are urgently required.

ObjectivesWe draw on institutional theory to explore the roles and actions of innovation teams and how this influences their behaviour and capabilities as ‘institutional entrepreneurs (IEs)’, in particular the extent to which they are both ‘willing’ and ‘able’ to facilitate transformational change in healthcare through service redesign.DesignA longitudinal qualitative study that applied a ‘researcher in residence’ as an ethnographic approach.SettingThe development and implementation of two innovation projects within a single public hospital setting in an Australian state jurisdiction.ParticipantsTwo innovation teams, with members including senior research fellows, PhD scholars and front-line clinicians (19 participants and 47 interviews).ResultsDespite being from the same hospital, the two innovation teams occupied contrasting subject positions with one facilitating transformational improvements in service delivery, while the other sought more conservative improvements. Cast as ‘IEs’ we show how one team took steps to build legitimacy for their interventions enabling spread and scale in improvements and how, in the other case, failure to build legitimacy resulted in unintended consequences which undermined the sustainability of the improvements achieved.ConclusionsAdopting an institutional approach provided insight into the ‘willingness’ and ‘ability’ to facilitate transformational change in healthcare through service redesign. The manner in which innovation teams operate from different subject positions influences the structural and normative legitimacy afforded to their activities. Specifically, we observed that those with the most power (organisational or professional) to bring about transformational change can be the least willing to do so in ways which challenge current practice. Those most willing to challenge the status quo (more peripheral organisation members or professionals) can be least able to deliver transformation. Better understanding of these insights can inform healthcare leaders in supporting innovation team efforts, considering their subject position.

This article examines trends in new media journalism, identifying an independent sector which began to emerge with the internet circa 2000. It finds that publications from initially single-person start-ups like Crikey, to the large circulation New Daily, have proved viable and durable, providing alternatives to mainstream print and broadcast media. They have specialised in politics while publishing also in many other fields, characteristically emphasising user participation in both production and funding and exploiting possibilities of new digital models. This article has case studies of the publications Independent Australia, and the New Zealand-based Asia Pacific Report, to further explain the independents’ motivation and mode of operation. It reviews the media environment in two parts: a first phase from 2000 to 2010 and a second major change after 2010 with smart phones and social media. Conclusions are made that the independent sector stands to play a central role in sustaining democracy.

This paper is an exploratory study investigating motivators of teenagers to both attend and not attend a climate change related protest event. Using open-ended surveys and focus groups, 16–19-year-old Australian students were asked about their motivators to attend and abstain from School Strike 4 Climate events. Through qualitative analysis and thematic coding, results show key motivators to attend a Strike include climate change and acts of political participation that provide youth with a public voice. Protest is positioned as a key part of teen political repertoires. Reasons for non-attendance included prioritizing schoolwork and low efficacy in protest or participatory action. However, low efficacy in climate change mitigation, or an outright rejection of climate science, was not evident in this sample. Overall, reasons for attendance and non-attendance at a Strike event were not direct mirror images of the other, and implications for inclusion of non-participants in further studies is discussed in this light.

Edelman and colleagues’ analysis of the views of Board members of Australian Research Translation Centres (RTCs) is well timed. There has been little study of Australian RTCs to date. We focus on their recommendations regarding knowledge mobilisation (KM) to open broader debate on the wisdom of regarding UK practices as a blueprint. We go further and ask whether successful RTCs might, as a result of responding to local context, create idiosyncratic structures and solutions, making generalisable learning less likely? There has been much invested in Australian RTCs and implications of government’s formative evaluation of their work is discussed. Five recommendations are made that could help RTCs: allowing system end-users a greater say in funding decisions, taking a broader, more democratic approach to kinds of knowledge that are valued; investing in methodologies derived from the innovation space; and, a creative attention to governance to support these ideas.

BackgroundPublic health policies and recommendations aim to be informed by the best available evidence. Evidence underpinning e-cigarettes policy recommendations has been necessarily limited due to the novelty of the technology and the lack of long-term epidemiological studies and trials. Some public health bodies have actively encouraged e-cigarette use whilst others have raised concerns over introducing new health risks and renormalising tobacco smoking. Using citation network analysis we investigated the author conflicts of interest and study funding statements within sources of evidence used by public health bodies when making recommendations about e-cigarette policy.MethodsWe conducted citation network analysis of public health recommendation documents across four purposively selected diverse jurisdictions: WHO, UK, Australia, and USA. We extracted all citations from 15 public health recommendation documents, with more detailed data collected for influential citations (used in 3+ recommendation documents). We analysed the relationships between the sources of evidence used across jurisdictions using block modelling to determine if similar groups of documents were used across different jurisdictions. We assessed the frequency and nature of conflicts of interest.Results1700 unique citations were included across the 15 public health recommendation documents, with zero to 923 citations per document (median = 63, IQR = 7.5–132). The evidence base underpinning public health recommendations did not systematically differ across jurisdictions. Of the 1700 citations included, the majority were journal articles (n = 1179). Across 1081 journal articles published between 1998–2018, 200 declared a conflict of interest, 288 contained no mention of conflicts of interest, and 593 declared none. Conflicts of interest were reported with tobacco (3%; n = 37 journal articles of 1081), e-cigarette (7%; n = 72), and pharmaceutical companies (12%; n = 127), with such conflicts present even in the most recent years. There were 53 influential citations, the most common study type was basic science research without human subjects (e.g. examination of aerosols and e-liquids) (n = 18) followed by systematic review (n = 10); with randomised control trial being least common (n = 4). Network analysis identified clusters of highly-cited articles with a higher prevalence of conflicts of interest.ConclusionPublic health bodies across different jurisdictions drew upon similar sources of evidence, despite articulating different policy approaches to e-cigarettes. The evidence drawn upon, including the most influential evidence, contained substantial conflicts of interest (including relationships with e-cigarette and tobacco industries). Processes to explicitly manage conflicts of interest arising from the underlying evidence base may be required when developing public health recommendations.

International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants’ mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.

To better protect public health from third-hand exposure to methamphetamine, it is important to understand the techniques and current practices used within the methamphetamine testing and decontamination industry in Australia. A survey was conducted focusing on business owners that advertised testing and/or remediation services online. They were also invited to participate in a follow-up phone interview upon completion. The survey demonstrated that testing and decontamination methods were highly varied, which was expected for an industry with no regulation. Most companies offered methamphetamine testing and remediation which could be a conflict of interest. Participants also shared personal experiences, including the conduct of other industry members, demonstrating both poor practice and/or the competitive nature of the business. Participating business owners were following Australian guidelines to the best of their ability, and many are advocates for regulation to be implemented within the industry. This would address the inconsistencies between companies and establish trust for industry members and the public. It would also provide significant public health protection, which is currently lacking. A more consistent approach to the testing and remediation of methamphetamine contamination, aided by regulation, would address the significant risk to public health caused by third-hand exposure to methamphetamine.

Introduction: This scoping literature review explored the characteristics and behaviours of a subset of Australia's older population: 'grey nomads', many who live and travel with type 1 or 2 diabetes mellitus. Grey nomads are people aged more than 55 years, who travel in caravans or motorhomes for extended periods of time around rural and remote areas of Australia. Grey nomads are challenging the established view of ageing in Australia by their lifestyle choices, which include social and economic contribution, independence and furthering of personal fulfilment. However, some evidence suggests that grey nomads experience health issues while in rural locations, which exerts a significant burden on already under-resourced Australian rural health services. This review seeks knowledge on grey nomads' self-management of diabetes while travelling, with the aim of understanding their experiences and identifying support services and strategies that would facilitate improved self-management. Furthermore, this review seeks knowledge of how Australia's rural and remote health services support the nomads with diabetes and the influence of this burgeoning population on such services. Methods: A scoping review methodology provided the methods to map the current evidence concerned with this broad and complex topic. A systematic six-step framework was adopted: identifying the research question; identifying relevant literature; selecting studies; charting the findings; collating, summarising and reporting results; and a final consultation. Results: The grey nomads in this review travelled long distances through the often-harsh Australian countryside where they sought, privacy, isolation, self-sufficiency and a closeness with nature. Although their motivations included life- and health-enhancing experiences, most grey nomads travelled with at least one chronic health condition, which they did not consider as a barrier to adopting a grey nomad lifestyle. However, many were under-prepared for their health needs when in rural or remote Australia. Specific literature concerning grey nomads and self-management of diabetes was not found but salient aspects of diabetes self-management were identified and included a well-developed relationship with their diabetes healthcare provider; a relationship that relied on ongoing communication and support. When travelling, the ability to form or sustain supportive relationships with local health care providers was limited due to sparseness of rural services and the perceived transient nature of the relationship. Increasingly, grey nomads utilised digital technology via telemedicine or social media sites for information and advice on health issues. The local pharmacies in rural and remote locations were also identified as sources of support and services. Conclusion: The literature showed that the grey nomad population had a similar distribution of chronic illness, including diabetes, to that of the general Australian population, but very little was published about how they self-manage conditions when in remote locations where healthcare services were limited. The emerging roles of digital technology and development opportunities for pharmacists offer new and innovative avenues to support grey nomads with diabetes while travelling in rural and remote Australia.

Context: Health research is important to effectively address the health disparities between Indigenous and non-Indigenous Australians. However, research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Justifiably then, people may be reticent to welcome researchers into their communities. Genuine commitment to community consultation, the fostering of partnerships and collaborative approaches maximise successful outcomes and research translation in these communities. Issue: Despite guidelines existing to try to ensure the needs of Aboriginal and Torres Strait Islanders are met through any research involving them, non-Indigenous researchers may not be fully aware of the complexities involved in applying these guidelines. This article explores how a team of Indigenous and non-Indigenous researchers understood and applied the guidelines during a 3-year dementia prevalence study in the Torres Strait. Their reflections on the practicalities involved in conducting ethically sound and culturally appropriate research are discussed. Lessons learned: Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just 'ticking the boxes' on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice.

Background: Primary health care (PHC) services are complex systems, shaped by an interplay of factors at individual, organisational and broader system levels. For Aboriginal and Torres Strait Islander PHC services, closer relationships with the people they serve, local knowledge of community, and cultural awareness are critical. Continuous quality improvement (CQI) has proven to be an effective process for identification of priority issues in health care delivery and for instigating the design, implementation and evaluation of improvement interventions in these settings. However, wide-scale variation in care quality persists partly due to the mismatch between CQI interventions and context.Methods: This critical review of implementation frameworks for CQI in Aboriginal and Torres Strait Islander primary health care was conducted in two phases: (1) a review of primary published implementation frameworks used in PHC contexts, and (2) a comparison of key features of these frameworks with quality concepts identified by high-improving Aboriginal and Torres Strait Islander PHC services in remote Australia.Results: We found nine primary implementation frameworks previously used in PHC contexts guiding interventions within and between macro (broader contextual) level; meso (health service) level; and micro (community and inter-personal) level systems. There was commonality between these frameworks and key quality concepts in Aboriginal and Torres Strait Islander PHC. However, none of the frameworks covered all concepts with rare consideration of communities driving health improvement, two-way learning (integrating cultural knowledge into healthcare provision), and caring staff—engendering trusting relationships with community enacted through respect.Conclusion: Respect, as a secret essence, privileges the importance of culture, and is an essential element of CQI implementation frameworks for positive change in Aboriginal and Torres Strait Islander PHC services. It is essential to work with communities to design workforce models that grow a caring stable workforce to ensure improvements in quality of care that are effective for their context.

Background Public health advocacy strategies facilitate policy change by bringing key health issues to the forefront of public and political discourse, influencing decision-makers and public opinion, and increasing policy demand. The Victorian Salt Reduction Partnership (VSRP) was established in 2014 in response to inadequate government action to improve population diets in Australia. This study aimed to evaluate the success of the VSRP’s advocacy strategy in achieving policy change. Methods Documentation of VSRP activities and outputs were collected, and semi-structured interviews conducted as part of a comprehensive process evaluation. For this study, the Kotter Plus 10-step public health advocacy evaluation framework was used to guide data extraction, analysis, and synthesis. Results A sense of urgency for salt reduction was generated by producing evidence and outlining the potential impact of a state-based salt reduction programme. This enabled the creation of a coalition with diverse skills and expertise, which facilitated the development of an innovative and collaborative advocacy action plan. A clear change vision was established, but communication of the vision to decision-makers was lacking, which reduced the impact of the programme as decision-makers were not provided with a clear incentive for policy change. As a result, while programme outputs were achieved, these did not translate to achieving broader strategic goals during a limited-term intervention in a political climate unconcerned with salt. Conclusions The Kotter Plus 10-step framework was a useful tool for evaluating the success of the VSRP advocacy strategy. The framework enabled the identification of key strengths, including the creation of the guiding coalition, and areas where efforts could be improved in future similar strategies, such as effective communication within partnerships and to decision-makers, to better influence policy and improve public health impact.

The Australasian Society for Physical Activity aims to advance the science and practice of physical activity in Australia, New Zealand, the Pacific Islands, East Asia, South Asia, Southeast Asia, and Oceania. Fun, enjoyment, and cross-disciplinary discourse are important to ensure the network of physical activity professionals and our collective voice continues to grow. In May 2021, Australasian Society for Physical Activity's Early Career Network curated an engaging online Physical Activity Debate attended by 206 professionals. This commentary provides a synopsis of the debate and the central arguments presented by the affirmative and negatives teams. The authors describe the debate format and interactive design of the online Physical Activity Debate to provide insights for future online events that aim to boost interaction among physical activity professionals from various disciplines. Refereed/Peer-reviewed

Purpose: One approach increasingly used by governments to deliver on public initiatives is to partner with private enterprise through public–private partnerships. This study is a qualitative process evaluation of an Australian state-wide workplace health programme “Get Healthy at Work” from the currently under-researched perspective of the private service providers. Methods: Semi-structured interviews were conducted with nine service providers. Interviews were transcribed and analysed inductively. Results: Service providers reported an alignment of motives and skills between the programme and their organizations as a benefit of the partnership. However, they also described misalignments: between the potential and realized value of the programme to businesses and service providers; the programme cycle and business operational processes; and the capacity building approach and businesses’ expectations of the service.Conclusions: Although several hallmarks of a well-functioning private–public partnership were evident, misalignments of process and expectations challenged sustained partnership involvement by providers. Careful consideration must be given to the ongoing management functioning of cross-sector engagement and partnering in health promotion practice in order to ensure public health goals are being met, but also that the model is mutually sustainable.

Background Pandemics such as COVID-19 are a serious public health risk for Australian Aboriginal and Torres Strait Islander communities, yet primary healthcare systems are not well resourced to respond to such urgent events. At the start of the COVID-19 pandemic, a federal government advisory group recommended a rapid, tailored Indigenous response to prevent predicted high morbidity and mortality rates. This paper examines the efforts of one ACCHO, which in the absence of dedicated funding, pivoted its operations in response to COVID-19. Gurriny Yealamucka Health Service (Gurriny) is the only primary healthcare service in the discrete Indigenous community of Yarrabah, Far North Queensland. Methods The research was conducted at the request of the Chief Executive Officer of Gurriny. Using grounded theory methods, thirteen Gurriny staff and five Yarrabah and government leaders and community members were interviewed, transcripts of these interviews and 59 documents were imported into NVIVO-12 and coded, and key concepts were compared, organised into higher order constructs, then structured into a theoretical framework. Results Gurriny responded to COVID-19 by leading with local solutions to keep Yarrabah safe. Four key strategies were implemented: managing the health service operations, realigning services, educating and supporting community, and working across agencies. These strategies were enabled or hindered by five conditions: the governance and leadership capacity of Gurriny, relying on the health taskforce, locking the door, “copping it”, and (not) having resources. A year after the first case was experienced in Australia and on the eve of vaccine rollout to Indigenous communities, there have been no COVID-19 cases in Yarrabah. Discussion The success of the locally led, holistic, comprehensive and culturally safe response of Gurriny suggests that such tailored place-based approaches to pandemics (and other health issues) are appropriate, but require dedicated resourcing. Key challenges were the fragmented and rapidly changing government processes, poorly coordinated communication and resource allocation channels, and bottlenecks in hierarchical funding approval processes. Conclusions The COVID-19 response in Yarrabah demonstrates the need for governance reform towards greater resourcing and support for local decision making by Aboriginal community-controlled health organisations.

Aboriginal and Torres Strait Islander Health Workers (A&TSIHWs) are a professional cadre of Australian health workers typically located in primary care clinics. The role is one of only two that is ‘identified’— that is, it must be occupied by an Aboriginal and/or Torres Strait Islander person — and holds specific responsibilities in relation to advocating for facility-level cultural safety. However, lack of understanding of the distinctive skills, scope and value associated with the A&TSIHW role remains pervasive in the broader health workforce. Positioned to represent the perspective of those working as A&TSIHWs, and drawing on 83 in-depth interviews with A&TSIHWs and others, this qualitative study reports on the core functions and distinctive orientation of the role, and seeks to articulate its distinctive value in the modern Queensland health service. Findings highlight the multifaceted (generalist) nature of the A&TSIHW role, which comprises three core functions: health promotion, clinical service and cultural brokerage. Underpinning these cross-cutting functions, is the role’s unique orientation, defined by client-centredness and realised through Indigenous strengths based ways of knowing, being and doing. The findings highlight how the A&TSIHW role is one of the only mechanisms through which Aboriginal and Torres Strait Islander knowledge can be brought to bear on context-specific adaptations to routine health service practices; and through which the impacts of lack of cultural or self-awareness among some non-Indigenous health professionals can be mitigated. The complexity of such work in a government health system where a dominant biomedical culture defines what is valued and therefore resourced, is under-recognised and undervalued and contributes to pressures and stress that are potentially threatening the role's long-term viability.

The identification and announcement of the COVID-19 pandemic has been a global issue. Disaster preparedness for internal and external threats is inherent within health care environments and requires agile thinking and swift remediation. Nosocomial infection is a risk for recipients of care, especially in hospital settings, which has implications for workforce planning. The aim of this case study was to examine the community response to the internal disaster of the first nosocomial COVID-19 outbreak within an Australian rural health care environment. A critical discourse analysis method was adopted to generate and analyse data collected from three different media platforms during a six-week period. Four main themes were distilled: actions and intent, loss, well-being and recognising choice, and community action. Phase two of the study interrogated these themes to expose the power positioning of speakers and their relationships to the audiences. Strengthening communication with local communities within health care environments must be a priority in any future rural workforce disaster preparedness planning. Maintenance of trust with health service provision and delivery in rural communities is imperative. The inclusion of a robust communication plan within any risk management strategy that meets the needs of the local users of health services is mandatory.