Context and aim: Diabetes mellitus (DM) poses a significant challenge to public health. Effective diabetes self-management education (DSME) interventions may play a pivotal role in the care of people with type 2 diabetes mellitus (T2DM) in low- and middle-income countries (LMICs). A specific up-to-date systematic review is needed to assess the effect of DSME interventions on glycaemic control, cardiometabolic risk, self-management behaviours, and psychosocial well-being among T2DM across LMICs.

Methods and analysis: The MEDLINE, Embase, CINAHL, Global Health, and Cochrane databases were searched on 02 August 2022 and then updated on 10 November 2023 for published randomised controlled trials (RCTs) and quasi-experimental studies. The quality of the studies was assessed, and a random-effect model was used to estimate the pooled effect of diabetes DSME intervention. Heterogeneity (I2) was tested, and subgroup analyses were performed. Egger’s regression test and funnel plots were used to examine publication bias. The risk of bias of the included studies was assessed using the Cochrane risk-of-bias tool for randomized trial (RoB 2). The overall assessment of the evidence was evaluated using the Grading of Recommendations Assessment, Development,and Evaluation approach. PROSPERO (CRD42022364447).

Translational outcomes: A total of 5893 articles were retrieved, and 44 studies (n = 11838) from 21 LMICs met the inclusion criteria. Compared with standard care, pooled analysis showed that DSME effectively reduced the HbA1c level by 0.64% (95% CI: 0.45% to 0.83%) and 1.27% (95% CI: -0.63% to 3.17%) for RCTs and quasi-experimental design studies, respectively. Further, the findings showed an improvement in cardiometabolic risk reduction, diabetes self-management behaviours, and psychosocial well-being.

Future actions: This review suggests that ongoing support alongside individualised face-to-face intervention delivery is favourable for improving overall T2DM management in LMICs, with a special emphasis on countries in the lowest income group.

Context and aim
Social media-related injuries and deaths are a global public health issue, particularly in and around aquatic locations. Much research has focussed on the ill effects of social media use on mental health, but accidents and other physical harms attributable to social media have been underexplored. The aim of this study was to codesign a risk communication campaign on Instagram with Queensland National Park and Wildlife Service, capitalising on our social media user surveys (n=509) and Influencer interviews (n=18), and evaluate its implementation via in person surveys at a national park location, alongside social media metrics.

Methods and analysis
The survey comprised predominately closed-ended questions about respondents’ use of social media, including if they used social media to find the national park location, whether they saw the risk communication campaign on Instagram, if the campaign changed their motivations to visit or to engage in risky behaviour at the location and demographic variables. Surveys were analysed via descriptive statistics and content analysis. Additionally, social media metrics were collected to understand the reach and impact of the social media campaign, including impressions, views, reach, and ad recall.

Translational outcomes
The campaign reached 1.1 million social media users, with 83.8 thousand engagements and 1.9 million impressions, 254 total saves of the posts, and 4 thousand link clicks which took users to landing pages which presented more risk information. Surveys revealed most users wished to receive risk information authorities (national parks) and found messaging most credible from authorities, and family and friends. Influencers were seen as potentially trustworthy but depending on their credibility and authenticity.
Future actions
Future research should seek to ascertain if engaging and collaborating with travel and tourism influencers is effective in delivering risk communication messages to social media users who visit aquatic locations where risky behaviour takes place. Influencers may be effective in communicating with social media users around health and safety behaviours in a more authentic manner that resonates with this demographic. Our results also suggest that social media users wish to see authorities communicate with them more frequently via social media.

Context and aim
LiveLighter® is a comprehensive program that utilises social-marketing and other strategies to improve the health and wellbeing of WA adults. Working closely with local government agencies allows LiveLighter® to leverage existing community programs and connections and extend the reach of the messages beyond paid media. This collaborative approach meets the mutual aims of local government programs and LiveLighter®; to improve the community’s health and wellbeing.

Methods and analysis
The ‘Move More’ campaign aims to encourage Western Australian adults to be more physically active by highlighting the intrinsic benefits of physical activity, like better mental health, more energy, and connecting with others. Important creative considerations included using a tone that was empowering, positive, and helpful, and representing a diverse range of people.

For the second wave of ‘Move More’ LiveLighter® collaborated with the City of Melville. The campaign was launched at the same time as the resumption of their free ‘yoga in the park’ sessions. LiveLighter® hosted an activation at the event, with a ‘big blue door’ and merchandise giveaways. Alongside the City of Melville, the LiveLighter® team promoted this event across multiple social media channels to encourage participation.

Translational outcomes
This collaboration was a success, with 60+ community members attending, and the campaign gaining coverage on radio and TV news. It also inspired other community programs and local governments to adopt the ‘Move More’ messaging within their communities. There were 1500+ views on the ‘Move More’ campaign web page that weekend.

Future actions
Nurturing collaborations has benefits for health promotion campaigns, local government campaigns and community members. Working closely with local government to achieve a mutual goal was effective in spreading the ‘Move More’ campaign messaging and is a strategy we encourage health promotion campaigns to trial.

Alcohol-related violence (ARV) is an important public health issue that causes harm throughout Australia. The impact of ARV extends further than those immediately affected, influencing emergency department clinical staff workplace safety and satisfaction, hospital inpatient bed capacity and consuming extensive healthcare funding and resources. Family and domestic violence (FDV) is another public health issue with far-reaching health, social and economic impacts. The relationship between alcohol and FDV has been reported in studies from multiple countries, where a major modifiable risk factor of FDV incidence and severity is alcohol use. Recognising that excessive alcohol consumption (EAC) and FDV commonly co-exist and cluster, there is a need to consider interventions targeting these issues when investigating methods for reducing ARV in WA.

A literature review was performed, with the aim of assessing outcomes of interventions targeting ARV, including FDV and EAC. Databases including Medline, Cochrane and PubMed were searched for English-language studies and grey literature published between 2010 and 2023 investigating interventions and strategies used to address ARV, FDV and EAC. Thirty-six studies meeting design criteria were selected for inclusion in the review. A critical narrative approach was used due to variability in study designs preventing quantitative analysis. Population-based interventions including alcohol taxation and minimum unit price for alcohol are effective measures in reducing ARV. Community-based interventions that restrict alcohol trading hours, reduce alcohol outlet density, impose alcohol restrictions, and change the drinking environment were protective against ARV. However, success of these interventions on FDV is heterogenous. Clinical-based interventions targeting FDV, and alcohol simultaneously found mixed results. Evidence for individual-based alcohol interventions addressing FDV and alcohol concurrently yields positive results.

The overall evidence base for interventions reducing alcohol-related violence is limited. Existing studies lack strong validity, necessitating a more rigorous evaluation into the effectiveness of interventions. Future interventions should focus on vulnerable groups at-risk of alcohol violence, address sociocultural determinants of intervention success and explore use of internet-based interventions.

These findings will inform the WA Health System Action Pan for Reducing Alcohol-Related Violence in response to recommendation 2b of the Sustainable Health Review.

Kidney disease disproportionately impacts Aboriginal and Torres Strait Islander peoples in Australia, yet treatment access and outcomes are not optimal due to the complex and culturally unsafe pathway to transplantation. Patient Navigator programs in South Australia and the Northern Territory are accepted by Community as a culturally safe way to improve access to the transplant waitlist, as patient experts can help guide and advocate for new patients from lived experience of dialysis and transplant. However, these programs currently operate independently across two jurisdictions that share one transplant unit. Existing Patient Navigators have identified that the coordination of programs is required to ensure sustainability and continuity of care from renal sites through to the transplant unit.

Our project (COMPASS) is led by Aboriginal and Torres Strait Islander researchers, and more importantly, Aboriginal and Torres Strait Islander Patient Navigators. Through our research, we aim to understand how coordinating Patient Navigator programs across four sites (Darwin, Alice Springs, Port Augusta and Adelaide) can help facilitate better care and outcomes for patients with renal failure.

By implementing communication channels and data-sharing systems, we are enhancing care coordination for patients travelling between sites. This approach has allowed Patient Navigators to identify and implement practical real-time solutions to issues, resulting in effective, Aboriginal-led change to patient journeys. Alongside the day-to-day implementation of this model, decolonising research methodologies such as Journey Mapping and Yarning Circles are being utilised to understand how Patient Navigators impact patient care and wellbeing from a patient perspective. This research also draws upon Patient Navigator and health professional/executive insights to determine how these positions can be best integrated and supported within health services.

The learnings from this project will inform recommendations around the implementation of Patient Navigator programs across different healthcare services, and drive advocacy for ongoing support and funding of these programs.

The majority of people living with dementia in Australia are living in the community and inappropriately designed public places put them, and their care partners, at risk of social isolation, with the consequent negative health impacts.
To understand the experience of people living with dementia when they visit their favourite public places, and the physical, social, societal and temporal influences on that experience, Constructivist Grounded Theory was used to explore the experience of the person living with dementia, those who support them, and those who influence the design of public places. Simple spatial analysis was used to identify the physical and social qualities of the favourite public place, and other places referred to, or visited with people living with dementia.
In taking a strengths-based, wholistic relational approach this research has highlighted the importance of communication between disciplines, sectors of the built environment and end-users, in assisting designers of the built environment to create public places that foster opportunities for inclusion. This research also revealed that there is a disconnect between discussions of inclusivity in health and the social sciences and those in the design disciplines of the built environment.
This brief presentation aims to start a conversation about different ways of knowing, and the contribution of relationships, time and awareness in improving communication and knowledge sharing between the diverse parties interested in improving inclusivity in the built environment.

Context and aim: Droughts have worldwide public health impacts, and evidence suggests that more populations have been impacted in recent years due to climate change.The intensity, duration, and frequency of these events are likely to increase, raising interest in understanding environmental determinants' role in public and individual health.While evidence indicates that environmental factors contribute significantly to violence, the specific influence of drought on sexual violence remains underexamined.This study aims to address this gap by examining the association between drought and sexual violence against adolescent girls and young women.

Methods and findings: The study uses cross-sectional, international data from the Violence Against Children and Youth Surveys. From February 2013 to July 2019, 34,349 females (13-24 years) were interviewed in 14 countries.We employed a random effects Bayesian Generalised Linear Model with varying intercepts to account for unobserved heterogeneity across countries, controlling for age, relationship status, school enrolment and wealth.Sexual violence was defined as a combination of variables that measured unwanted sexual contact, completed or attempted forced penetration, and pressured into sexual activity.The exposure variable, drought, was quantified in terms of duration and intensity using the Standardised Precipitation-Evapotranspiration Index (SPEI) with a 6-month timescale and ~50 square km spatial resolution.Exposure to prolonged drought periods was associated with higher odds of sexual violence, with an adjusted odds ratio of 1.22 (95% credible interval 1.22 – 1.22) and a posterior probability of 1.00, indicating a strong evidence with high degree of certainty.

Translational outcomes:This study provides novel evidence of the link between drought and sexual violence,highlighting a critical area for public health intervention.By delineating this association, the research paves the way for future policy development that can integrate violence prevention into broader climate resilience strategies.The findings offer a foundation for developing targeted interventions and cross-sectoral collaborations to reduce vulnerabilities in drought-prone areas.

Future actions:Future efforts should incorporate these insights into proactive policy-making that addresses climate change adaptation and violence prevention.Implementing community-based interventions to strengthen local responses to environmental changes and support violence prevention is also essential.By adopting a comprehensive approach, we can better protect vulnerable populations from the intertwined impacts of environmental and social challenges.

Dietary risk factors have a significant impact on the incidence of chronic diseases. It is important to create supportive environments to promote healthy eating behaviours. Eating out of home has become increasingly common in recent decades, making community dining environments particularly relevant.

We undertook a scoping review to explore the types of nutrition interventions implemented in community dining settings to enhance healthy eating behaviours. A systematic search of databases (MEDLINE, Embase, CINAHL, Scopus, and Business Source Complete) and grey literature identified 2714 peer-reviewed and 14 grey literature studies, with 22 studies (21 peer-reviewed, 1 grey literature) ultimately included. The interventions were categorised into four types: point of purchase, recipe reformulation, menu reformulation, and community-wide health promotion. Analysis revealed that 86% of the studies reported significant improvements in primary outcomes such as nutrition environments, customer awareness, and healthy choices. Co-design by investigators and stakeholders was common. Most studies reported high acceptability of changes by vendors and positive receptivity by patrons, indicating the feasibility of introducing stepwise nutritional changes to a community-based dining environment.

The findings indicate that many community-based dining venues have successfully implemented nutrition interventions, resulting in improved dietary behaviours by patrons. By addressing individual, social and environmental factors, these initiatives effectively enhanced nutritional quality of food offerings and promoted healthier choices amongst patrons. These successes demonstrate the value of integrated, context-specific strategies in promoting healthier eating behaviours and improving population nutrition outcomes.

Future efforts should focus on developing tailored, community-focused nutrition interventions with robust evaluation frameworks. Engaging key stakeholders in the design and implementation process is crucial to ensure interventions are contextually relevant and sustainable. Additionally, including a rigorous evaluation framework and standardised evaluation tools in the design and implementation will enhance the effectiveness and scalability of nutrition interventions in promoting healthier eating behaviours.

Obesity has become an increasingly common risk factor for several chronic conditions and presents a significant burden to healthcare systems in Australia and worldwide. In Australia, obesity contributed toward 8.4% of the total disease burden attributed to weight-related conditions with recent findings showing that one in four children and adolescents (25%) were obese or overweight as in 2017-18. Obesity is influenced by several socioeconomic, biological, behavioural and lifestyle factors, thereby contributing to the complexity of the condition.
This study explores the relationship between family and infant characteristics and the early introduction of sugar sweetened beverages (SSBs) among infants in Sydney, Australia. Mothers-infant dyads from an ongoing birth cohort study were interviewed at 8, 17, 34, and 52 weeks postpartum. Multivariable logistic regression was used to identify family and infant factors independently associated with the likelihood of early introduction of SSBs (<52 weeks of age). Of the 934 mother-infant dyads interviewed, 53.5% of infants were introduced SSBs before 52 weeks. The likelihood of introducing SSBs by single mothers was almost double than that of married women. Mothers from high socioeconomic backgrounds were 51.3% less likely to introduce SSBs than mothers in other disadvantage categories. Chinese-born mothers had 54.3% lower odds of introducing SSBs than Australian mothers. Infants who were introduced solids ≥ 17 weeks were 41.4% less likely to be introduce SSBs compared to those who consumed earlier than 17 weeks. Given the long term impact that infant nutrition has, tailoring health promotion programs for these vulnerable groups may delay SSB introduction to the recommended time and improve overall childhood health.

What is the problem/issue that requires public health action? [Context and aim]
Neurological disorders, recognised as the leading cause of disability and the second leading cause of death globally, often lead to significant challenges in meal preparation and consumption for those affected. These challenges frequently result in malnutrition, which negatively impacts health and quality of life and may hasten the disease process.

What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]
Our research team, in collaboration with You Plate It and with sustained engagement from the neurodegenerative community, has initially developed a meal box solution tailored to individuals with mild neurological disabilities. However, this meal box solution is not suitable for people with moderate disabilities who present with cognitive, movement, and swallow difficulties, limiting their ability to prepare ingredients, cook, and eat meals.

How has this been used in practice? [Translational outcomes]
To address this gap and unmet need, we are expanding this initiative using a double-diamond approach. This project employs a structured framework consisting of the following steps: 1) Conducting a comprehensive literature review to understand the complexities of meal preparation and eating difficulties faced by this population, along with the contributing factors; 2) Conducting an online activity via Miro to capture the perspectives of people living with the disease and health professionals on the difficulties of preparing and eating meals, as well as on the utility of a meal box solution; 3) Hosting co-design workshops, both in-person and online, that bring together people with lived experience and health professionals to gather detailed insights into the practical challenges of meal preparation and consumption, and the utility of a meal box solution; 4) Developing a prototype meal box solution in collaboration with our industry partner, You Plate It; 5) Coordinating a simulation session with community members to practically test the meal preparation process using the meal box, noting any difficulties experienced to iteratively refine the prototype; and 6) Implementing a feasibility trial with individuals who have moderate neurological disabilities to assess the practicality and acceptability of the meal box solution.

What actions should we take in the future to address the problem/issue? [Future actions]
This multi-phase project aims to enhance dietary independence and overall quality of life for those with severe neurological challenges, providing a tailored nutritional solution that is both practical and supportive of their health needs.

Context and aim:
The role of local governments (LGs) is critical in fostering healthier food environments through public health plans (PHPs), policies and actions. However, addressing the food environment in PHPs is hampered by LGs lacking comprehensive, quantifiable, evidenced-based information regarding food provision and access. To address this issue, the WA Food Atlas tool was collaboratively designed through multi-sector partnerships. The process, insights and outcomes from this co-design undertaking will be shared.

Methods and research findings:
This project brought together a multi-disciplinary team of researchers with expertise in nutrition, public health, environmental health, urban planning, geography, spatial science and geographic information systems, data management and computer science. LG stakeholder collaboration involved multiple methods to ensure comprehensive fit-for-purpose outcomes, including stakeholder workshops and user experience sessions designed to collect diverse viewpoints, validate data and facilitate iterative design enhancements. This approach led to the development of an evidence-based tool funded by Healthway (the WA Food Atlas) that is both robust and practical for LG use. The WA Food Atlas maps, measures and monitors food access across communities using food business data routinely collected and stored by LGs. It offers comprehensive geospatial food access metrics and interactive maps, providing objective evidence that LGs can use to inform their PHPs.

Translational outcomes:
The WA Food Atlas currently includes two timepoints, 2019 and 2022, for metropolitan Perth LGs (n=32), profiling access to fast-food and fruit and vegetables outlets. The WA Food Atlas is being used by LGs to initiate discussions on food access, trends, priorities and gaps. It provides clearer oversight of food business operations to enhance food regulation, policymaking and surveillance systems. It supports decision-making processes, generates local evidence for crafting obesity prevention and intervention strategies and developing comprehensive PHPs and policies.

Future actions:
Going forward, it is essential to continue the multi-sector collaboration to ensure the Food Atlas is continually updated and remains useful for LGs. Integrating new food business data time points, including health metrics, bespoke data sets (e.g., food insecurity) and expanding it Australia-wide will allow the analysis of broader patterns and correlations, further enhancing the utility and relevance nationally.

Context

In April 2022 the Secretary of the Victorian Department of Health (department) issued Secretary Directions requiring specified healthcare workers in prescribed health settings in Victoria to be vaccinated against influenza by 15 August each year.

The Directions apply to Category A and B healthcare workers (those at highest risk of contracting or transmitting influenza to other healthcare workers and patients) who are employed or otherwise engaged by public and private hospitals, ambulance services and public sector residential aged care facilities.

The influenza vaccine mandate seeks to protect the health and safety of healthcare workers in these services and mitigate the risk of transmission of seasonal influenza to patients.

Aim

To use a mixed-methods approach to explore the early impact of the introduction of the influenza vaccine mandate on the delivery of the healthcare worker influenza vaccination program in Victorian health services.

Method

VICNISS Healthcare Associated Infections Surveillance Coordinating Centre is responsible for coordinating annual program surveillance data on behalf of the department. VICNISS undertook a survey and focus group interviews with health service leads responsible for delivering workplace vaccination programs.

Research findings

We will present quantitative and qualitative outcomes on
1. healthcare worker vaccination coverage, declinations, and unknown status in Victorian public healthcare organisations from 2018 to 2023.
2. the experiences of healthcare worker influenza vaccination program implementers in 2022 and 2023.

Translational outcomes and future actions

This presentation will explore the early impact of the introduction of the influenza vaccine mandate in Victorian health services, describe program leads’ experiences of managing the mandate at a local level, and present barriers and enablers to implementation.

Context and aim: Gestational Diabetes Mellitus (GDM) affects around 16% of all pregnancies with significantly greater prevalence in non-White ethnicities. GDM increases the risk of type 2 diabetes (T2DM) after delivery by up to 10-fold, but this risk could be reduced by lifestyle intervention. Program enrolment and completion in lifestyle interventions differ by social indicators. This study investigated inequities in a state-wide T2DM prevention program for women who had GDM.
Methods and analysis/research findings. An equity audit (2014-2022) was conducted to uncover underserved populations among women with a history of GDM within the Life! program, using the PROGRESS-Plus framework (Place of residence, Race/ethnicity/culture/language, Occupation, Gender/sex, Religion, Education, Socioeconomic status, and Social capital Plus age, smoking, disability and sexual orientation). Interviews were conducted with women with a history of GDM from rural and regional or South Asian backgrounds, and with their health professionals. Women from metropolitan areas were more likely to complete the program (AOR = 1.69, 95% CI: 1.29–2.22). Women with South or Central Asian background were less likely to complete the program (AOR = 0.67, 95% CI: 0.48–0.94). Nine women and six health professionals from the rural and regional group and twelve women and nine health professionals from the South Asian group were interviewed. The interviews revealed key barriers to engagement including low awareness of the program, low awareness of T2DM risks following GDM, lack of systematic referral pathway, health service gaps in the postpartum period and limited consultation time with general practitioners. Additional issues were revealed for South Asian women including health services not accommodating a family-centric approach to health, lack of access to Medicare, and health services that are not culturally responsive.
Translational outcome: Co-design workshops are underway between health professionals, women, and the Life! program staff members to develop effective pathways to reach these populations.
Future actions: Regular equity audits should be conducted for health services to uncover underserved populations. The experiences of these groups with health services should be explored and used as a basis to co-design person-centred care that is tailored to the specific needs of the group.

Is the value of our health services being destroyed for a large cohort of Australians? Compared to women, Australian men have a lower life expectancy, higher death rates in younger age groups, usually from preventable causes, and less healthy life years. Less than 40% of Australian men say they have regular primary preventative health check-ups and 80% say they will only go to the doctor when feeling sick.

Men have cited barriers to using preventative health services such as threat to masculinity, feeling uncomfortable in the health service environment, and perceived risks such as hidden costs and inconvenient access options. These barriers indicate the value of the service offered is being reduced or destroyed, somewhere in the customer journey.

This research surveyed 296 young men who had not used a preventative health service two years beforehand to identify different resistance value co-destruction behaviours and their antecedents. The research also sought to find where in the customer journey these value co-destruction behaviours might be reduced.

Structural equation modelling found a hierarchical relationship between four resistance value co-destruction behaviours: accidental, postponement, rejection, and opposition. Three perceived risks (functional, emotional, and social) fully mediated relationships between antecedents and passive and active value co-destruction behaviours. Furthermore, active value co-destruction behaviours (rejection and opposition) can be reduced early in the customer journey.

Findings indicate for young men, active value co-destruction behaviours are likely to be reduced when there is open communication decreasing the impact of perceived risks of using a service. Specifically, when perceived emotional risk (e.g. feeling embarrassed) and social risk (e.g. using a service when not sick) are reduced earlier in the service encounter, so are the value co-destruction behaviours. To increase men's likelihood of using the service again, practitioners can mitigate value co-destruction when young men first access a preventative health service.

What is the issue that requires public health action?
Healthway, is a WA Government statutory body that works across sectors to achieve health outcomes. Measuring outcomes from cross-sector collaboration is essential to demonstrate the effectiveness of interventions. It supports data-driven decision-making, continuous improvement and adaptation to evolving needs, ensuring resources are allocated efficiently.

What have we learned to address this issue?
Over the last two years, Healthway has worked with the University of Western Australia to develop an Evaluation Framework to demonstrate the impact of Healthway’s cross-sector investment. The Framework consists of four overarching pillars "Activity", "Knowledge Attitude Behaviour", "Organisational" and "Sustainability" that map broadly onto the outcomes being sought through these collaborations. Within the pillars there are 13 discrete elements which enable rigorous evaluation activity that documents both the delivery and impact of funded projects. The Framework allows evaluation of each project in isolation, but also serves to amass information about performance of partnerships when considered together in groups e.g. all sports, or all arts, or across the community as a whole.

How has this been used in practice?
The Framework provides a practical and manageable approach to evaluation for organisations with limited capability and time, and also caters for a wide range of projects. It guides organisations to set common partnership objectives and following project delivery enables organisations to measure and then reflect on overall project success.

What actions should we take in the future to address the issue?
Clear evidence of impact justifies funding and facilitates the replication and scaling of successful models, informing policy development. Engaging and empowering communities through measurable results enhances their involvement and ownership of health initiatives. Additionally, understanding outcomes provides comprehensive insights into the interconnected contributions of various sectors, fostering a more integrated approach to public health.

What is the problem/issue that requires public health action? [Context and aim]

Local governments (LGs) are recognised as playing an important role in fostering healthier food environments for their communities through public health policies and actions. The mandate for Western Australian (WA) LGs to develop a public health plan (PHP) recognises the importance of LGs engagement with their community to improve public health outcomes. The aim of this study was to explore what LGs are proposing to do to improve the local food environment according to their PHP.

What do we know or have we learned to address this problem/issue, and how has this finding been derived? [Methods and analysis/research findings]

A desktop audit of all WA LG websites (n=139) was undertaken between July – October 2023 to identify publicly available PHPs. All commitments specified within these PHPs that related to food environments were identified and thematically analysed. Eleven food environment focus areas (FA) were established.
Of the 139 LGs, 48 had publicly available PHPs and all included at least one FA dedicated to improving food environments (average 5.5, range 2-9). The most prevalent FAs were alcohol reduction (n=44, 92%); food quality and safety (n=43, 90%); and healthy food policy and provision (n=37, 77%). FAs with the fewest commitments were food affordability (n=6, 13%) and food waste reduction initiatives (n=6, 13%). Overall, most of the commitments lacked clarity, a clear strategy for how they would be achieved and an evaluation plan.

How has this been used in practice? [Translational outcomes]

This study found that LG PHPs covered a broad range of focus areas to improve the local food environment. However, due to the lack of clarity and comprehensiveness of the commitments made, he complexity of achieving public health impact through food environment interventions may not be well understood, and a more comprehensive and strategic approach to public health planning is needed.

What actions should we take in the future to address the problem/issue? [Future actions]

Over a third of WA LGs have progressed the development of PHPs and include commitments related to improving the food environment. For effective change, LGs require evidence-based data, more resources and support to further their understanding of public health planning in relation to food environments, and additional capacity and strong partnerships to develop more considered and comprehensive PHPs. Additionally, evaluation of the implementation of the commitments and their impact is required.

Context and Aims
Currently, many low and middle-income countries are experiencing rapid urbanization, with a constant increase of rural-to-urban migration. As a consequence, diet changes from a traditional towards a Western-like diet are expected. To test this assertion this study examined the dietary patterns of rural-to-urban migrants and lifetime rural and urban residents in Bangladesh.

Methods and Findings
The diets of rural-to-urban migrants, their lifetime rural dwelling sibs and lifetime urban residents were assessed by an interviewer-administered validated food frequency questionnaire. A total of 427 male participants aged ≥18 years were included in the analysis. Mean reported energy intake was higher in rural group compared to migrants and urban (mean±SD 3930±1028, 2823±914 and 2625±992 Kcal/day resp., p<0.001). The same pattern was seen for carbohydrate and protein intake, however, the proportion of energy from fat was highest in urban residents (17%) followed by migrant (13%) and rural residents (12%). Good fats like mono and poly-unsaturated fatty acid showed a decreasing trend from rural to migrant to urban (p<0.001). The highest frequency intake of fish, leafy vegetables, other vegetables and fruits were among the lifetime rural group whereas the consumption among migrants and urban residents were similar and significantly lower (p<0.001). Most migrants reported dietary change since migration to city (40% to 76%) for items like oily foods, fast food, soft drinks, energy drinks, processed/canned foods, red meat and eating out.

Translational outcomes
Dietary intake is of interest because of its association with prevention of chronic diseases like cancer, diabetes, cardiovascular diseases. The results from this study indicate that migration from rural to urban areas may have undesirable changes to the migrants’ diet.

Future actions
To develop useful dietary recommendations for rural-to-urban migrants, qualitative research looking in depth at the reasons and modifying factors of changes to their diet are thoroughly needed.

What is the issue that requires public health action?
Investigation into the effectiveness of cultural sensitivity and competence education on the knowledge and delivery of culturally safe healthcare amongst overseas-trained doctors.
What do we know and how has this finding been derived?
Australia has relied, to varying extents, on overseas trained doctors (OTDs) for its medical workforce. Providing culturally safe healthcare for Aboriginal and Torres Strait Islander peoples is crucial, particularly in areas where accessing adequate healthcare services, is challenging. There is a vital need for effective learning and delivery of culturally safe healthcare education amongst incoming OTDs with limited experience of caring for indigenous populations.

Whilst studies have demonstrated the utility of cultural education amongst healthcare professionals such as nursing, midwifery, and medical students, there is relatively little known about the responses of OTDs in other health professional education programs.

This pilot study will be the first study conducted within Australia to explore overseas-trained doctors’ delivery of cultural safe healthcare in response to current educational resources. The study will consist of a survey sent to OTDs practicing within Bayside Health Service following completion of the Aboriginal and Torres Strait Islander Capability Module. The survey will utilise a validated Cultural Capability Measurement Tool to measure cultural capabilities as described by The Aboriginal and Torres Strait Islander Health Curriculum Framework.

How has this been used in practice?
These findings will be used to help build the evidence to demonstrate the utility of cultural education amongst healthcare professionals, and further understand the impact of cultural education on the learner.

What actions should we take in the future to address the issue?
To date, there is no agreement within the literature as to what style of training is the most useful or effective. Further research is also needed to investigate the most effective format of cultural education, as well as their extended impact on patient health outcomes.

The COVID-19 pandemic was instrumental in highlighting the critical importance of engaging multicultural communities in public health. Due to a lack of pre-existing engagement and barriers such as, language, trust, and cultural differences however, governments and mainstream organisations struggled to effectively engage with these communities when needed.

Bicultural workers (BCWs) can play a vital role in addressing these challenges. They act as cultural bridge, drawing upon their lived experiences, language proficiency, cultural knowledge, and community connections to engage communities, facilitate culturally safety, and co-design programs that are responsive to community needs.

Despite the critical role of BCWs, many mainstream organisations lack experience in employing them and the skills to support them effectively. BCWs have also expressed a lack of opportunity for formal employment and training, as mainstream organisations generally seek cultural expertise from volunteers.

cohealth launched its bicultural program in 2017, with an aim to enhance BCWs' capacity, build professional recognition of the role, and improve cohealth’s engagement with refugee communities. Since then, cohealth BCWs have achieved over 200,000 engagements with people from refugee backgrounds, delivering programs co-designed with community to respond to their needs, ultimately improving their health and wellbeing.

In 2019, cohealth also developed 'The Professional Standards for Bicultural Work', a set of best practice guidelines to facilitate employment and support for BCWs. Over 1800 staff members from different organizations across Australia have since been trained in these standards, with 98% reporting improved confidence to employ and support BCWs, to improve engagement with multicultural communities.

The impact of the bicultural program has been significant and has contributed to enhanced health equity among refugee communities in Victoria. We must continue to build understanding of the benefits of working with BCWs and overcome barriers to their employment. When governments and mainstream organisations recognise BCWs as integral partners, multicultural community engagement, service accessibility, and cultural safety will improve, ultimately ensuring better health equity outcomes for all.

Context and aim
Most older Cambodians live in rural areas where healthcare resources are scarce. Because of this, concerns arise regarding this group’s health, particularly when they need to access, understand, and use information and services to make health-related decisions. Although data indicates an ageing population, there is limited research on older ethnic minority groups. This study sought to identify the health and health literacy needs of older people living in ethnic minority villages in Cambodia.

Methods
This qualitative research was conducted in two Muslim and two Indigenous communities in Cambodia between March 2023 and January 2024. Seventeen structured interviews and nine in-depth interviews were conducted with participants aged 60+ across the four sites. Data were analysed thematically to explore the participants’ needs in health care and health-related information.

Findings
All participants believed that access to public health services was limited or unavailable to older people. Despite having limited income, many (n=25) sought treatment from private health providers. More than half of the participants required their children and immediate family to assist them in receiving treatment due to the distance to health facilities, financial constraints, and language barriers. Only two participants felt they could manage their health and well-being. Moreover, it was observed that participants were vulnerable to the spread of misinformation. For all participants, health information shared among villagers with similar health conditions or experiences was their primary source of knowledge.

Conclusion
This study found that the Cambodian healthcare system responds poorly to the health needs of older people from ethnic minority backgrounds in rural areas. Findings also indicated that social support and local community health literacy are crucial within these populations. Therefore, a participatory approach to health literacy development is required to identify and respond to the distinct health needs of older ethnic minorities living in rural Cambodia.

Context and aim:
The World Health Organization states there is unequivocal evidence that food marketing influences food preferences and eating habits. Defining ‘unhealthy’ food is the most complex and critical aspect of unhealthy food marketing restrictions. This study aimed to assess the development of Food Classification Schemes (FCSs) applicable to Australian government nutrition policies, to determine what else is needed to implement unhealthy food marketing restrictions.
Methods and research findings:
The following Australian government-led or endorsed FCSs were reviewed for consistency with recommendations for developing fit-for-purpose FCSs. Model A: National interim guide to reduce children’s exposure to unhealthy food and drink promotion; Model B: Food Standards Australia New Zealand Nutrient Profiling Scoring Criterion; Model C: Health Star Rating System; and Model D: World Health Organization Nutrient Profile Model for the Western Pacific Region. Publicly available information describing development of each FCS was synthesised for the following attributes: purpose of the FCS, target population, decision making about the FCS design, FCS validation.
Purpose of the FCS: Models A and D were developed to support restrictions of unhealthy food marketing; Models B and C were developed for front-of-pack labelling purposes. Target population: Models A and D were developed to protect children; Models B and C were not targeted. Decisions about FCS design: There was no publicly available information describing design decisions for Models A, B or C, and limited information for Model D. FCS validation: All Models have undergone none or limited validity testing.
Translational outcomes:
Development of Australian government-led or endorsed FCSs defining unhealthy food for nutrition policies has not benefitted from the same level of transparency as those developed in other jurisdictions. To date, there are no Australian government restrictions of unhealthy food marketing and selection of the most appropriate FCS is highly contested, indicating more work is needed.
Future actions:
Given the absence of transparent development processes and limited validity testing for any FCS applicable in Australia, more work is needed to select and operationalise a fit-for-purpose model. Recommendations include examining the impact of design decisions made during development and undertaking an extensive validation process for the selected model.

Context and Aim: The research project AKction incorporates Indigenous cultural practices and lived experience to improve the outcomes of CKD. It does so by privileging the lived experience of Aboriginal people in renal health care by employing researchers from this background. As Chief Investigators on the project, Kelli, Rhanee and Nari, all kidney care patients and advocates, have played leadership roles where their knowledge is valued and respected. Kynesha, a young Aboriginal woman, supported them in this process. This presentation will highlight the importance of connecting to culture by learning language, keeping spirit strong through holistic approaches, and embedding culturally safe practices. It will also argue for the value of those with lived experience playing central roles in the research.

Research findings, translational outcomes: Nari highlighted the significance of passing down the Ngarrindjeri language, which contributes to a rich cultural heritage and a promising future for Mob. She played a critical role in advocating for healthcare improvements, such as ensuring the availability of dialysis chairs in the Aboriginal-run Kanggawodli hostel in South Australia. This effort has made dialysis treatment more accessible and culturally appropriate for Indigenous patients.
Rhanee emphasizes the complex interplay between mental, physical, spiritual, and emotional health. She emphasies that spiritual strength is deeply connected to environmental factors and social interactions within one's culture and community utilising Ganma by intertwining knowledge systems. As a peer navigator and chief investigator, Rhanee advocates for the inclusion of lived experience perspectives in renal health research and practices. Her work supports patients at the early stages of CKD, guiding them through the healthcare system. Kelli underscored the benefits of engaging with cultural practices, such as language, connecting with community Elders and practicing Dadirri. Kelli, as head of the National Kidney Transplantation Taskforce (NIKTT), has focused on collecting and analysing data on Indigenous CKD patients and reducing wait times for kidney transplants. Her leadership has been pivotal in identifying gaps and fostering improvements in healthcare delivery. Kynesha brought her understanding of structure and systems that meaningfully support those with Lived Experience to contribute. Kynesha has incorporated existing evidence regarding lived experience, intertwined with the outcomes of AKction to collective evidence of the value of those with lived experience playing an active role in research rather than simply consultative.

Future Actions: This collaborative approach fosters co-creation and benefits both healthcare providers and patients. It ensures that Indigenous voices play a critical role in shaping policies and programs that enhance health outcomes for Indigenous communities. To address the complexities, there must be more diversity to improve research methodologies by having Indigenous researchers shape policy and research. Indigenous decision-makers hold a critical role in shaping policies and programs that can benefit Indigenous communities and health outcomes.

Climate change has been declared the “single biggest health threat facing humanity” by the World Health Organization. Children under five years of age bear an estimated 88% of the additional disease burden caused by a changing climate, and every organ system has been found to be impacted. A range of interventions have been introduced to reduce the harms of climate change on child health outcomes, but few have been scientifically assessed. We did a systematic review to collate and synthesise the available global evidence.

Fifty-eight studies were identified examining the effects of various interventions on child health in response to climate change. Heat interventions included green space, heatwave warning systems, maternity ward relocation, educational brochures, and high school sports guidelines. Water, sanitation and hygiene interventions included household cisterns, as well as various national-level and school-level programs. Interventions for disaster risk management included school educational programs, post-flood deployment of midwives, and behavioural strategies for pregnant women during wildfire events. Respiratory interventions included retrofitting schools and houses, educational brochures, green space, and pneumococcal conjugate vaccines. Mental health interventions included post-bushfire counselling and green space in schoolyards. Vector-borne disease interventions included insecticide-treated nets, indoor residual spraying, and artemisinin combination therapy. The co-benefits of mitigation for child health were also examined. Studies mainly modelled child health outcomes under various pollution reduction scenarios. Specific mitigation strategies included green space and city-level transportation policies.

Overall, there was a scarcity of literature available. This has significant ramifications for policy. Without quality evidence, the effectiveness of child health interventions integrated within existing climate change policy is unknown. There may be little to no action being taken globally to address this crisis; and where actions have been outlined in policy, their level of implementation may be inadequate to provide meaningful improvements for child health.

Children who are exposed to positive, stimulating environments in their first eight years of life experience optimal foundations for their ongoing development. The neighbourhoods in which young children live and interact has received increasing attention in Australian and global policy agendas and initiatives. With cities rapidly expanding, families with young children are increasingly moving to suburban neighbourhoods, such as those in Melbourne’s growth areas. But these neighbourhoods may be less supportive of children’s development because of less infrastructure and fewer services compared with inner-city neighbourhoods. Understanding which and how neighbourhood features contribute to equitable early childhood development across different geographic contexts, is needed to inform place-based interventions and urban planning guidelines or plans.

The Early Data to Decisions Project is a mixed methods study aimed at identifying what makes a child-friendly neighbourhood and which specific built environment features support optimal early child development in different neighbourhood settings. In 2023-24, we used an online mapping activity using Public Participation GIS (PPGIS) software and semi-structured interviews to understand lived experiences of parents and their young children (4-8 years) living in 2 inner city and 2 growth areas in Melbourne. We sought to understand their lived experiences of their neighbourhoods, and the aspects of their neighbourhoods that they feel are important to their development, mental health and wellbeing. PPGIS is a map-based survey method that allows spatially referenced perceptions and experiences of the environment. Participants were asked to mark on a map places they usually visit, those that are important to them, and answered questions about each place. To our knowledge, this is the first time PPGIS mapping techniques were used with pre-school aged children and their parents.

This presentation will outline preliminary parent-child dyad findings while highlighting lessons learned from the field in recruiting participants, conducting PPGIS mapping techniques and interviews with preschool-aged children, and analysis and translation of PPGIS data. We will offer recommendations for addressing the practicalities of applying PPGIS methods with this age group. The findings will also be used to inform the development of objectively-created neighbourhood indicators for policy and practice. This project was funded by VicHealth.

Context and aim
An infodemic is the overwhelming amount of information, accurate and otherwise that accompanies an acute health event. This includes misinformation and disinformation, but also the questions and concerns people have, and information voids. During COVID-19, the impact of the infodemic has been seen internationally, with well evidenced impacts on public health. While infodemic mitigation and management work is now well developed from the COVID-19 emergency, there is a need to better understand prevention work and how a coordinated, comprehensive strategy that takes a systems approach for prevention for Australia could be developed.

Methods and analysis
The healthy information environment model defines the elements that impact on the information environment across: policy; commercial determinants of health; credible, accurate health information; health information equity; and digital, media, information, science and health literacy. Underpinning these are the social determinants of health. Approaching a preventative strategy that takes a systems approach, looking broadly at the drivers and determinants of infodemics is an important next step for infodemic management.

Translational outcomes
A preventative strategy will benefit the Australian community by raising awareness of the impact of infodemics, by increasing community resilience to identify and understand and strengthen workforce and government capacity to respond. Australians are diverse and looking at a range of ways solutions have been implemented globally is vital. Prevention is better than reacting, and with the significant lessons learnt during the COVID-19 pandemic, proposing a coordinated approach will help to better prepare Australia for the next pandemic.

Future actions
An infodemic is what happens during a health emergency, but the impact of a poor information environment is being seen across health issues with evidence of misinformation impacting health issues such vaping, non-communicable diseases, climate change, vaccination, as well as social issues such as the recent Voice referendum. Rather than just focussing on individual health issues, a cross-cutting coordinated approach is needed. Having more understanding of the infodemic as an overall health determinant and what works on a structural and strategic level to improve it is important. Infodemic management is a new field and there is a need to upskill the workforce.

What is the problem that requires public health action?

Many Australian health strategies and programs specify priority population groups where there is either a higher prevalence or risk, or concerns that mainstream strategies do not effectively reach some population groups. However, there is a risk that even as the number of named priority groups grows, some populations may remain invisible, particularly if there a dearth of data to raise their profile as a population warranting prioritisation. There is also a risk that health funding and policies become siloed around different population groups, and the common ‘causes of the causes’ may be missed.

What have we learned to address this problem?

In the UK and Ireland , this has been partially overcome by the now widely used concept of Inclusion Health, which can be defined as a field that seeks to prevent and address health and social inequalities experienced by groups of people who often have multiple overlapping risk factors for poor health, including poverty, trauma or social exclusion. Inclusion Health thus is an umbrella concept and approach to health equity, that can be applied across multiple settings and issues.

How has this been used in practice?

The litmus test for the usefulness of any concept is how it has been applied. International examples of how Inclusion health has had traction in government policy, service commissioning and efforts to avoid people ‘falling through the cracks’ of the health system will be shared.

What actions should we take to address the issue?

The Inclusion Health concept and approach could be a useful approach in Australia. It resonates with this PHAA conference highlighting the need for public health to be collectively responsive to the diversity of voices and community needs .