Background: High quality smoking data is crucial for assessing smoking-related health risk and eligibility for related health interventions. While smoking information collected in primary care practices (PCPs) is a major data source, little is known about its quality. This project reviewed the PCP smoking data quality referencing the smoking data collected in the Māori and Pacific Abdominal Aortic Aneurysm (AAA) screening programme.
Methods: The review involved two stages. In Stage 1, the concordance was assessed of the PCP smoking data recorded close to AAA screening episodes and the data collected from participants at the AAA screening session. Inter-rater reliability was analysed using Cohen’s kappa scores. In Stage 2, longitudinal smoking status was reviewed of a subset of potentially misclassified never or ex-smokers or those with missing smoking data in PCP records identified in Stage 1. Data were mapped and analysed for current smoker (smoke at least monthly), ex-smoker (stopped >1 month ago) and never smoker (smoked <100 cigarettes in lifetime).
Results: A total of 1716 (93%), of the 1841 people underwent AAA screening, had PCP smoking information. Stage 1 PCP smoking data showed 82% concordance with the AAA data (adjusted kappa 0.76). Fewer current or ex-smokers were recorded in PCP data. In the Stage 2 analysis of discordant and missing data (n=313), 93 participants remained enrolled in the 29 participating PCPs. Of them, smoking status has been updated for 43%. Smoking data on quantity, duration, or quit date were largely missing in PCP records. The AAA data of ex-smokers who were classified as never smokers in the Stage 2 PCP data (n=27) showed a median smoking cessation duration of 32 years (range 0-50 years), with 85% (n=23) having quit >15 years ago, and four persons, <15 years ago.
Conclusions: A concordance of 82% (adjusted kappa 0.76) between the PCP smoking data and the AAA data is consistent with international findings. PCP data captured fewer current and ex-smokers. Smoking data accuracy and recording on details could be improved. Intervention programmes based on smoking status should consider additional mechanisms for inviting eligible participants given the level of misclassification identified in this study.

Problem
Fine debt has a disproportionate impact on people experiencing disadvantage, often entrenching hardship, and pushing them towards further contact with the justice system. Hardship can also prevent people from participating fully in society, often putting them in a position to compromise on health and safety to meet their day-to-day demands.
Following a successful proof of concept of the Child Car Restraint Diversion Program led by NSW Police and Revenue NSW, we sought to define the development framework for evidence-based diversion programs, and reduce the impact of fines on people experiencing hardship at an earlier intervention point.
Method
An analysis of fine debt in Bourke, Moree and Broken Hill was conducted, as well as a literature review identifying 36 fine diversion programs in Australia and internationally.
Results
The Child Car Restraint Diversion Program achieved 87% compliance, and realised safety benefits through this proof of concept. Additionally, the proof of concept resulted in $30,000 in avoided debt and 272 avoided demerit points.
The literature review discovered that there was no standardised method for developing diversion programs, and there was little to no research on the impact of fine diversions on behaviour change.
The research uncovered opportunities to divert people identified as vulnerable at an early fine accumulation stage (within 10 fines) to avoid perpetuating hardship and disadvantage.
Lessons
Finding empirical evidence to link hardship with the acquisition of fines is difficult, but developing diversions can lessen the impact of hardship. A higher proportion of individuals with <10 fines are being serviced by the NGO sector to resolve their fine debt, likely drawing resources from the more complex high need individuals who are resolving fine debt.
With little precedent of diversion programs targeting the impact of fines on vulnerable people, the research put forward an innovation approach to the fine diversion development framework.

Background
WA-Health’s Syphilis Point-of-Care (PoC) testing program, established in July 2020 by WA Health’s Communicable Disease Control Directorate (CDCD), funds WA health services to conduct syphilis PoC testing. The program comprises a quality framework, training and PoC testing materials. CDCD conducted a mixed methods process and impact evaluation of the WA syphilis PoC testing program.
Methods
Data analysed included those routinely reported by all 31 services that participated in the program from its establishment to the evaluation period (September 2022), and responses to a survey distributed to all 21 enrolled services in November 2022. The survey included questions about PoC test usage, benefits, barriers, and enablers. Responses were analysed using thematic analysis. Service performance was assessed on proportion of tests used for patient testing and time from service’s enrolment to first patient test.
Results
During the evaluation period, 13,700 PoC tests were distributed, 2156 (15%) were used for patient testing, and there were 119 reactive results. Eleven services (52%), responded to the survey. Thematic analysis identified seven themes: testing target populations; immediate results; extra work; embedding PoC testing into service delivery; staff champions; and capability to test. Top performing services commenced patient testing within two months of enrolling and used 51% of tests for patient testing, compared to poorer performing services that, used on average 14% of tests for patient testing and took up to 18 months to patient test. Staff champions and embedding PoC testing in routine processes enabled sustainable PoC testing.
Conclusions
Evaluation results indicated that some program requirements did not add value and reduced patient testing. To address these inefficiencies, CDCD is reforming quality control requirements, facilitating strategies for embedding syphilis PoC testing into service delivery, and expanding options for staff training and funding of test strips/reagents.

Context and aim: Physical activity is beneficial to health, yet a substantial proportion of Australians do not meet minimum physical activity recommendations. The advent of autonomous vehicles is expected to result in changes that both promote and discourage people from being physically active. However, attempts to predict the mechanisms via which autonomous vehicles will affect engagement in physical activity have yielded mixed results. This study employed a novel approach to examine potential lifestyle shifts and identify groups at risk of becoming more sedentary in an autonomous future.

Methods and analysis: An online survey was completed by 1078 adult Australians, which included a vignette describing a future scenario where autonomous vehicles and delivery systems are in common use and urban designs are better suited for walking and cycling to destinations. Respondents reported their anticipated changes in exercise levels in this future and provided reasons for their anticipated behaviours. Frequency analyses were used to identify predicted changes in physical activity and associated reasons. Two generalised linear models were run to identify factors associated with predicted decreases and increases in exercise.

Translational outcomes: While only minor decreases in physical activity were predicted overall, younger people, those who were less active, and those who spent more time using cars and public transport were more likely to anticipate being more inactive in an autonomous future. Reduced incidental exercise, convenient autonomous delivery services, and increased access to door-to-door transport were key factors contributing to anticipated declines in physical activity.

Future actions: The introduction of autonomous vehicles will need to be carefully managed to avoid reduced physical activity among certain groups. Developing better active transport infrastructure, improving safety for vulnerable road users, and restricting autonomous delivery services could help to create environments that are more conducive to active lifestyles when autonomous transport technologies are commonplace.

In 2012, the Legal Australia-wide survey demonstrated that although one-fifth of Australians experience 3 or more legal problems in a given year, many don’t seek legal help and are unlikely to walk through the doors of a legal aid or community legal assistance service. If we do seek legal help, we are more likely to speak to a non-legal advisor such as a health professional, who can quickly feel they are being asked to operate beyond their scope and time.
This legal evidence sparked a grassroots movement of community lawyers moving out of their offices into the most unlikely of places – hospitals, community health and social service settings – to provide legal assistance where, when and how people need it. This innovative collaboration, where legal assistance is integrated into services supporting people’s health and wellbeing is known as health justice partnership (HJP).
Health Justice Australia is a national centre of excellence to support more than 125 HJPs across Australia. Health staff and lawyers are collaborating across fragmented, siloed service systems. They respond to the needs of people disproportionately affected by health inequity and injustice including women and children experiencing family, domestic or sexual violence, Aboriginal and Torres Strait Islander peoples, people with mental health conditions, people experiencing homelessness, people with disability and older people experiencing elder abuse. HJPs focus on addressing social determinants of health, such as poor-quality housing, family violence, sexual violence, credit and debt, elder abuse, discrimination, involvement with the child protection system and more. By addressing these, HJP seeks to prevent issues escalating to crisis and promote the health and wellbeing of individuals and families.
In this session you will learn what HJP means for public health – the rationale, outcomes, practice – both nationally and in WA.

Objective: This study aims to evaluate the knowledge level among emergency nurses regarding
radiation exposure and the implementation of protective countermeasures during nuclear and
radiological emergencies.

Methods: A cross-sectional study was conducted using a self-structured questionnaire with 15 true false questions, divided into three categories: radiation exposure protection measures, radiation exposure health effects, and decontamination procedures.
Descriptive statistics summarized
demographic characteristics and item scores. Inferential statistics, including t-tests, ANOVA, and
linear regression models, were used to analyze associations and differences between variables.
Results: A total of 396 nurses participated in this study, most participants were young (68.69%
aged 18-30), predominantly female (68.69%), largely held bachelor’s degrees (68.69%), were
single (63.64%), had ≤4 years of experience (56.06%), worked in public health facilities (88.89%),
and notably, 85.35% had not received training in medical response to radiological or nuclear
accidents. For radiation protective measures, the average score was 2.32 ± 0.99, with 86.36%
showing poor knowledge. In the area of radiation exposure effects, the score was slightly higher
at 3.27 ± 0.91, with 62.63% of nurses in the poor knowledge category and 37.37% in the acceptable
range. The lowest scores were observed in decontamination knowledge, where the average was
1.46 ± 1.07, with 92.42% demonstrating poor knowledge. Overall knowledge was measured at an
average score of 7.06 ± 1.68, with 97.47% of nurses categorized under poor knowledge and only
2.53% achieving an acceptable level.
The results also revealed a significant difference in the
overall knowledge mean score between nurses working in private and public health facilities (P = 30.034), with those in private hospitals scoring higher on average (7.77 ± 1.82) compared to their counterparts in public hospitals (6.97 ± 1.65)

Conclusion: This study found a poor knowledge level among emergency nurses regarding
radiation protective measures during radiation emergency and highlights a critical need for enhanced and standardized training in radiation emergency preparedness among nurses,
particularly in public hospitals.
The gaps in knowledge identified in this study could significantly impact the effectiveness of healthcare responses in radiation emergency scenarios.

Keywords: emergency nursing, radiation exposure, protective measures, decontamination,
radiation emergencies

Compared with the general population, people with psychosis faced increased risks of COVID-19 infection and worse related outcomes, including hospitalisation and death. Despite calls to prioritise this population for vaccination during the height of the pandemic, vaccination rates remained low. Individuals’ uptake (or not) of available vaccinations is driven by both access to vaccines and their willingness to accept them. We aimed to explore these barriers for people with psychosis and offer recommendations for improving health-related outcomes for this group. This mixed-methods cross-sectional study was conducted with 233 participants who had taken part in the Perth (WA) metropolitan catchments of the Survey of High Impact Psychosis. Recruitment was conducted by telephone between September 2022 and September 2023. Participants were asked questions regarding vaccination status, sources of health and COVID-19-related information, perceived vaccination importance, and other factors influencing vaccination decisions. Reflecting WA’s high vaccination coverage generally, over 90% of respondents reported being fully vaccinated, while 6% had refused vaccination. However, many participants described barriers to accessing the vaccines that reflected their experiences as people living with mental illness. Over half said they were not contacted or approached by anyone about getting vaccinated for COVID-19. All under- and non-vaccinated participants denied receiving information on vaccine timing and safety, while almost half of those fully vaccinated had received such information. Under- and non-vaccinated participants reported lower levels of trust in their General Practitioner or psychiatrist regarding their health compared to those who were vaccinated, yet simultaneously reported higher levels of trust in other types of healthcare professionals. Participants who did not believe vaccination was important cited concerns related to vaccine side-effects and efficacy as deterring their uptake, while those placing high importance on vaccination sought to prevent illness in themselves or others, to provide peace of mind, and were motivated by mandate policies. Our study underscores the importance of tailored vaccination programs and enhanced communication strategies to improve vaccination rates among people with psychosis. We recommend upskilling nurses and case managers to provide information and encourage vaccination in this population, and offering vaccines to inpatients or at mental health facilities during routine appointments.

Context and aim: The Yolŋu (Aboriginal people of North-East Arnhem) continue to struggle with culturally inappropriate and potentially retraumatising encounters within the health system. This includes messaging that can provoke anxiety , is deficit-focused, disempowering and created without local input. An action research project initiated by Yolŋu leaders who observed the negative impacts of Covid messaging, is creating accessible, shareable resources used to generate actions to build marrparaŋ (a Yolŋu wellbeing-aligned concept), including within the local health service. We report here on the first stages of a developmental evaluation.

Methods: evaluation measures are devised by Yolŋu co-researchers; as resources are being designed and implemented, the conversations also include hoped for outcomes.. Data collection includes: facilitators’ participant observations, researcher discussions , and surveys and focus groups conducted by local researchers. Data analysis is led by Yolŋu researchers and carried out iteratively.

Findings: Key concepts with the potential to shift communication about health issues and that have been implemented in practice by Yolŋu researchers include:
1. Marrparaŋ – there are multiple meanings relating to this concept that are being incorporated into local trauma-informed care resources and training.
2. Trauma, addiction, depression and anxiety – a mamuy (octopus) metaphor has been developed to build understanding, hope and strategies to overcome the ‘grip’ of what gets in the way of wellbeing.
3. The term risk causes fear and confusion – the project explores using language around signs and pathways.
4. Value of action research using Yolŋu research methods based in metaphors including hunting and weaving and ‘sit, listen and observe’ – fosters, trust, self-determination and community strengthening.

Translational outcomes: Translation of findings into practice is embedded in the project. Ongoing priorities are to share our learnings with Yolŋu researchers from other areas and to support other organisations in better aligning their services with (and advocating for) local wellbeing needs and aspirations. In the long-term we advocate for revised funding models to allow Aboriginal communities greater determination in the delivery of health services.

Digital health interventions can widen health inequity because a level of eHealth literacy is required to access and utilise these interventions. This is significant to the most vulnerable and disadvantaged groups in our society, including those with lower eHealth literacy. Digital health interventions present barriers to those with low eHealth literacy as they often include specialised language, lack adequate guidance, and present confusing interfaces. People with lower eHealth literacy are less able to take advantage of digital health interventions to manage and improve their health because of these barriers. Improving interventions for participants with low eHealth literacy is crucial to ensure that they can deliver on their potential to provide scalable and effective support, especially to those who are most vulnerable and disadvantaged. Conversational agents, technologies that interact with people using natural language, can be incorporated into digital health interventions to mitigate eHealth literacy barriers. Well-designed conversational agents can improve accessibility by engaging users in dialogue alongside on-screen instruction, translating specialised language into everyday terms, assessing comprehension in real-time, and offering voice-based interactions as an alternative interface. A systematic review synthesising evidence from 20 papers on the design features of conversational agent-enabled interventions and their impacts on user engagement found that most of the current research evaluating these interventions has typically been of prototypes in quasi-experimental studies. The heterogeneity of interventions and outcomes limited comparisons but was crucial for obtaining broader insights into design impacts. Key findings relevant to this topic included identifying variation in engagement between different population sub-groups, and that conversational agents require unique and novel design considerations, such as deciding whether an agent should adopt a directive or supportive persona. With no standardised design strategies in this emerging field, developers are at risk of making inconsistent decisions that lead to conversational agents ineffectively addressing barriers to access, such as low eHealth literacy, which compromises the potential of these technologies to improve accessibility. Future research should adopt design strategies that are adaptive to diverse user needs and aligned with unique considerations. Enabling conversational agents to cope with low eHealth literacy more effectively will improve health outcomes for all.

Wastewater surveillance is an efficient and cost-effective population based surveillance tool. SARS-CoV-2 wastewater surveillance programs were employed throughout Australia during the COVID-19 pandemic, resulting in the development of innovative sampling and analytical methods, and informing public health responses. Polio wastewater surveillance is being undertaken in limited Australian jurisdictions, either State-led or on behalf of a World Health Organisation surveillance program. Globally, wastewater surveillance methods are being used or developed for a range of other diseases including for respiratory and gastrointestinal viruses, high impact pathogens including measles and antimicrobial resistance (AMR), and emerging diseases such as avian influenza. These methods complement traditional surveillance and facilitate population-level surveillance independent of individual health seeking behaviours, access to healthcare and testing practices, and have a role in pandemic preparedness and early detection.

Western Australia (WA) adopted qualitative SARS-CoV-2 wastewater surveillance in late 2020, moving to quantitative wastewater surveillance for COVID-19 in 2022, and adding influenza virus and respiratory syncytial virus (RSV) in mid-2023. Samples are collected twice weekly from three major Perth metropolitan wastewater treatment plants (WWTPs) and processed by PathWest. Genome sequencing of SARS-CoV-2 to understand emerging variants is also undertaken. WA also takes part in the national polio wastewater surveillance program, collected monthly on a rotational basis from the same three WWTPs.

Correlation analysis of SARS-CoV-2, influenza and RSV between wastewater concentrations and clinical cases has identified statistically significant correlation. Quantitative and sequencing results for SARS-CoV-2 are made publicly available, and used by public health, hospital clinicians and high-risk settings such as residential aged care to inform public health measures. Evaluation of the impact of RSV immunisation on wastewater surveillance is a focus of the WA wastewater surveillance program in 2024. Additional research and development work is being undertaken to understand the role of wastewater surveillance for other communicable diseases, including measles, monkeypox and flaviviruses.

There is potential for widespread adoption of wastewater surveillance in Australia building on global findings and lessons learnt to date to better understand the prevalence of communicable diseases and emerging pathogens. Standardised testing and reporting across jurisdictions would better inform public health practices and policy.

Australia is recognised as an international leader in men’s health. However, life expectancy for men is lower than that for women, many deaths are due to preventable causes, and certain priority population groups experience a higher burden of adverse health outcomes. Following the release of the National Male Health Policy (2010), the Australian Government released the National Men’s Health Strategy 2020-2030 (NMHS) to set out a framework for action to ensure every boy and man in Australia is supported to live a long, fulfilling, and healthy life. One of the key actions of the NMHS is to undertake a gap analysis of existing men’s health-related research, policies and strategies, program evaluations, and datasets in Australia. Until now, the evidence for the health and wellbeing of men and boys had not been identified and assessed.

The Gap Analysis of Evidence for Male Health (GAME), commissioned by the Australian Government, is an extensive review of men’s health policy, data, and best practice evidence in Australia since 2010. The project encompassed reviews of datasets, policies across all jurisdictions, and a best practice review of academic and grey literature. The project team were tasked with identifying existing evidence on male health in Australia and providing recommendations for future research and strategies for improving the health and wellbeing of Australian men and boys.

We reviewed 21,552 academic studies, 3079 grey literature reports, 108 datasets, and 592 policies and strategies for men’s health in Australia. We analysed existing evidence for the specific priority population groups and key health issues identified in the NMHS.

Specific findings are still to be released, but we found that gaps exist across all sources of evidence for specific male population groups and priority health issues.

Our recommendations will help inform future policy, funding, and research directions for men’s health in Australia.

Context and aim: Brain white matter hyperintensities (WMHs) reflect the risks of stroke, dementia, and overall mortality. Existing epidemiological and machine learning-based studies lack to fully explore factors associated with WMHs. This study used a novel hypothesis-free machine-learning approach, to uncover potential risk factors for the development of WMHs using information from the world’s largest brain imaging study.
Methods and analyses: We used a hypothesis-free gradient boosting decision tree (GBDT) approach, and conventional statistical methods, to discover risk factors associated with WMH volume. The GBDT models considered data on 2891 input features in WMHs prediction, collected ~10 years prior to WMH volume measurements from 44,053 participants. After ranking the contribution of each feature to model prediction using Shapley values, the top 3% of features were taken forward to epidemiological analyses using linear regression adjusted for basic confounders. Results are presented using βs and 95% confidence intervals, with false discovery rate adjusted P-value <0.05 used to declare statistical significance.
Research findings: Multiple sclerosis had the strongest association with WMH volume. Several adiposity-related measures (weight, waist circumference, whole body fat-free mass) contributed to WMH prediction, as did indicators reflecting metabolic health (glycated haemoglobin, glucose, blood pressure, hypertension, alkaline phosphatase, gamma glutamyltransferase, aspartate aminotransferase, microalbumin, total protein, and urate). Of lifestyle factors, smoking had the strongest association. Associations were also seen for lung function parameters, red blood cell indices and monocyte count.
Translational outcomes and future actions: These analyses suggest obesity, high blood pressure and related metabolic abnormalities as key contributors to WMH volume. Interventions targeting hypertension and metabolic disturbances, may provide opportunities to prevent or reduce the development WMHs. Further research is needed to establish causal relationships and develop effective intervention strategies based on these insights.

Abstract
Background:
Urban-rural inequality in the utilization of quality antenatal care (ANC) is a well-documented challenge in low- and middle-income countries, such as Bangladesh and Pakistan, limiting utilization of maternal healthcare service and impeding progress towards achieving the Sustainable Development Goals. Therefore, our study focuses on uncovering the key factors contributing to the urban-rural inequality in the utilization of quality ANC in Bangladesh and Pakistan and also demonstrates inter-country differences.
Methods:
We used nationally representative data from the latest Demographic Health Surveys (2017-2018) of Bangladesh and Pakistan for women aged 15–49 years who had given at least one live birth in three years preceding the survey. We decomposed inequalities in the utilization of quality ANC among urban and rural women in Bangladesh and Pakistan using the Oaxaca, the Blinder, and related decompositions for nonlinear models. To quantify covariate contributions to the urban-rural inequality in the utilization of quality ANC, we employed the Blinder-Oaxaca multivariate decomposition analysis for nonlinear response models.
Results:
Our findings show that the utilization rate of quality ANC was 38.50% in Bangladesh and 46.97% in Pakistan. In Bangladesh, the average total difference in predicted quality ANC rates between the urban and rural areas was 0.2012 (p­value≤0.01), while in Pakistan, the average total difference was 0.2524 (p­value≤0.01), regardless of the type of decomposition used. For detailed decomposition, the leading and significant covariate categories (p­value≤0.01) consistently contributing to the urban-rural inequality were the richest wealth quintile (Bangladesh: 38.05%, Pakistan: 18.23%), women's secondary and higher education (Bangladesh: 3.74%, Pakistan: 14.67%), husband's secondary and higher education (Bangladesh: 7.55%, Pakistan: 6.69%), media exposure (Bangladesh: 8.92%, Pakistan: 9.16%), and women's autonomy (Bangladesh: 2.34%, Pakistan: 2.16%).
Conclusion:
There is significant urban-rural inequality in Bangladesh and Pakistan, which is more pronounced in Pakistan. Wealth difference has the largest contribution percentage among the common significant predictors for both countries. In Pakistan, women's education is the second largest contributor to inequality, while in Bangladesh, it is media exposure. To effectively address the inequality in quality ANC between urban and rural areas, strategies must be tailored to these specific differences in the identified characteristics.

Adolescence is a sensitive phase of human development where individuals are particularly vulnerable to developing mental health problems (MHPs). A disproportionate amount of young people live in low-and-middle income countries (LMIC), where a majority of the people living with mental health problems across the globe reside. South Asia, comprised of LMICs, has dearth population wide data on adolescent mental health. Therefore, this systematic review aims to review the evidence about the nature, prevalence and determinants of mental health problems experienced by adolescents living in South Asia.

Searches were conducted in four online databases. Two independent reviewers performed title, abstract, full-text screening, data extraction and quality assessments. Extracted data were categorised into two groups: school-based studies (SBS) and non-school-based studies (NSBS). Data were further stratified according to country and condition and narratively synthesised.

Of the 5847 records identified in the searches, 117 met the inclusion criteria. Most (n= 87) were SBS. In these, highest prevalence ranges were reported for anxiety disorders in India (1.5-81.6%). In NSBS (n=30), highest prevalence estimates were for depression in India (0.4-98.5%). Determinants/ associated factor groups include individual characteristics; violent victimisation; poor family/home/school environment or peer relationships; already experiencing MHPs and substance use/abuse. Increased physical activity, adequate nutrition, safe homes, being unmarried females, higher maternal education, positive family environment, peer support/friendship, higher education level and engaging in extra-curricular activities showed a positive correlation with mental well-being.

Prevalence of MHPs among South Asian adolescents are substantially higher than those reported in high-income countries. Determinants include social, cultural, environmental and socioeconomic factors often beyond individual control. Protective factors show a potential starting point for mental health policies, programs and future research. Population level epidemiological data incorporating research methods appropriate to the cultural context is also needed.

What is the issue that requires public health action?
Efforts to address chronic food insecurity in Australia are dominated by food relief, and while a valuable service, it has yet to reduce chronic food insecurity. New knowledge can help to evolve service models and inform government investment, however, research must be co-produced and translated to ensure that it informs policy and practice. Building on previous collaborations, researchers initiated a partnership research project in South Australia, through Australian Research Council Linkage funding (2021-24). Policy and practice partners included two state government agencies (health-wellbeing, and human services) and three community sector food relief organisations. The project aimed to work in partnership to translate existing guiding principles into practice, and inform service and system improvements.

What have we learned to address this problem/issue, and how has this finding been derived?
Participatory methods and integrated knowledge translation guided research activities, which included co-design, knowledge brokering and commissioned research. Methods to evaluate outputs and impacts included a stakeholder database, partner discussions, and tracing of policy and practice influence.

How has this been used in practice?
While a research protocol was initially developed, this evolved into a commitment to working together with partners to ‘meet them where they were at’, responding to emergent need while pursing research objectives. Research activities and methods remained flexible, to fit within partners’ contexts and constraints. Support requests (40%), information-seeking (20%) and relationship-building (20%) were the most common types of contact over time. Nine reports (commissioned work and co-authored peer-reviewed articles) and co-design outputs were produced, informing practice and service funding redesign. Researchers brokered knowledge for the sector during times of staff turnover in government.

What actions should we take in the future to address the issue?
New knowledge and tools co-produced through the Linkage are immediately relevant and can be translated to service delivery, and can be used to inform government investment in food and social systems. National research funding can enable additional state-based action alongside knowledge co-production. Future projects and grants are being progressed with existing and new partners, to address new topics of practice and policy importance.