Lydia Hearn

Reaching perinatal women online: the Healthy You, Healthy Baby website and app.

Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs) to offer healthy lifestyle counselling. In response, todays Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.

National Safe Schools Framework: Policy and practice to reduce bullying in Australian schools

In 2003 Australia was one of the first countries to develop an integrated national policy, called the National Safe Schools Framework (NSSF), for the prevention and management of violence, bullying, and other aggressive behaviors. The effectiveness of this framework has not yet been formally evaluated. Cross-sectional data collected in 2007 from 7,418 students aged 9 to 14 years old and 453 teachers from 106 representative Australian schools were analyzed to determine teachers’ perceptions about the extent of implementation of the NSSF, teachers’ capacity to address student bullying, and students’ reports of bullying in their school, 4 years following the framework’s dissemination. While methodological issues limit the findings, schools appear not to have widely implemented the recommended safe school practices, teachers appear to need more training to address bullying, especially covert bullying, and bullying prevalence among students seems relatively unchanged compared to Australian data collected 4 years prior to the launch of the NSSF.

Online healthy lifestyle support in the perinatal period: what do women want and do they use it?

Unhealthy weight gain and retention during pregnancy and postpartum is detrimental to mother and child. Although various barriers limit the capacity for perinatal health care providers (PHCPs) to offer healthy lifestyle counselling, they could guide women to appropriate online resources. This paper presents a project designed to provide online information to promote healthy lifestyles in the perinatal period. Focus groups or interviews were held with 116 perinatal women and 76 PHCPs to determine what online information perinatal women and PHCPs want, in what form, and how best it should be presented. The results indicated that women wanted smartphone applications (apps) linked to trustworthy websites containing short answers to everyday concerns; information on local support services; and personalised tools to assess their nutrition, fitness and weight. Suggestions for improvement in these lifestyle areas should be practical and tailored to the developmental stage of their child. PHCPs wanted evidence-based, practical information, presented in a simple, engaging, interactive form. The outcome was a clinically endorsed website and app that health professionals could recommend. Preliminary evaluation showed that 10.5% of pregnant women in Western Australia signed up to the app. Use of the app appeared to be equitable across urban and rural areas of low to middle socioeconomic status.

Cyberbullying in Australia: Is School Context Related to Cyberbullying Behavior

Information and Communication Technologies (ICT) permeate all aspects of society in Australia. Since the introduction of the Internet into Australia some 20 years ago the majority of Australian households (72% in 2008 – 2009) have access to the Internet (Australian Bureau of Statistics, 2009). By mid-2009 over 24 million active mobile phones services were used in Australia, more than one phone per person (Australian Communications and Media Authority, 2010). Increasingly young people are entering the mobile phone market with 76% of 12 to 14 year olds having their own phone (Australian Bureau of Statistics, 2010). Despite the infiltration of mobile phones into the youth market, the majority of phone contact (60%) made is to family members rather than peers (Australian Bureau of Statistics, 2009).

Oral health care in residential aged care services: barriers to engaging health-care providers.

The oral health of older people living in residential aged care facilities has been widely recognised as inadequate. The aim of this paper is to identify barriers to effective engagement of health-care providers in oral care in residential aged care facilities. A literature review was conducted using MEDline, CINAHL, Web of Science, Academic Search Complete and PsychInfo between 2000 and 2013, with a grey literature search of government and non-government organisation policy papers, conference proceedings and theses. Keywords included: dental/oral care, residential aged care, health-care providers, barriers, constraints, and limitations. A thematic framework was used to synthesise the literature according to a series of oral health-care provision barriers, health-care provider barriers, and cross-sector collaborative barriers. A range of system, service and practitioner level barriers were identified that could impede effective communication/collaboration between different health-care providers, residents and carers regarding oral care, and these were further impeded by internal barriers at each level. Findings indicated several areas for investigation and consideration regarding policy and practice improvements. While further research is required, some key areas should be addressed if oral health care in residential aged care services is to be improved.

International approaches to Indigenous dental care: what can we learn?

Indigenous populations around the world have significantly poorer oral health and inequalities in access to dental care largely attribute to the social determinants of health. Reviewing international literature offers an opportunity to better understand appropriate approaches for policy and practice in Australia. This article is a descriptive narrative review based on primary research literature discussing informative international approaches to Indigenous dental care. Approaches identified in the literature included integration of dentistry with primary health care and traditional practice, training and use of oral health professionals and approaches used at different stages of life, particularly in the management of early childhood caries. The international literature provides a range of approaches to Indigenous oral health. Tailored, culturally appropriate family and community based initiatives that address the multidisciplinary issues confronting Indigenous communities were most highly regarded.

Barriers and enablers for oral health care for people affected by mental health disorders.

BACKGROUND People with mental health disorders are reported to have poorer access to dental services and poorer oral health outcomes. The aim of this paper is to analyze current published work regarding barriers and enablers for oral health outcomes and access to dental care for adults with mental health disorders which will be addressed from individual, organizational and systemic perspectives METHODS: A narrative review based on a search of the relevant published work regarding oral health for people with mental health disorders was undertaken using Medline, Web of Science, ERIC and Psychlit. Any relevant systematic reviews were highlighted in this process along with primary studies. RESULTS The published work repeatedly verified poorer oral health and inadequate access to dental services in people with mental health disorders. The published work identified barriers at individual, organizational and systemic levels. Much of the published work focused on barriers with less focus on enablers and interventions. CONCLUSIONS Considerable investigation of barriers had not elucidated options to improve care or outcomes.

Oral health care in remote Kimberley Aboriginal communities: the characteristics and perceptions of dental volunteers.

BACKGROUND Aboriginal Australians face significant disparities in oral health and this is particularly the case in remote communities where access to dental services can be difficult. Using volunteers to provide dental care in the remote Kimberley region of Western Australia is a novel approach. METHODS This study comprised an anonymous online survey of volunteers working with the Kimberley Dental Team (KDT). The survey had a response fraction of 66% and explored volunteer demographic characteristics, factors that motivated their involvement, perceptions of oral health among Aboriginal communities, and barriers and enablers to oral health in remote Aboriginal communities. RESULTS Volunteers were more likely to be female, middle-aged and engaged in full-time employment. The two most common reasons reported for volunteering were to assist the community and visit the Kimberley region. Education and access to reliable, culturally appropriate care were perceived as enablers to good oral health for Aboriginal people in the Kimberley while limited access to services, poor nutrition and lack of government support were cited as barriers. CONCLUSIONS Volunteers providing dental services to remote areas in Western Australia had a diverse demographic profile. However, they share similar motivating factors and views on the current barriers and enablers to good oral health in remote Aboriginal communities.

SCOPE childhood obesity project bridges policy/practice gap

With more than 20% of preschool children and almost 50% of women of childbearing age in Australia either overweight or obese, there is mounting pressure on public health policy and primary care practitioners to work with parents to enhance healthy family behaviours. In practice, however, a variety of system-level barriers, attitudinal and behavioural barriers, and knowledge, skills and training barriers prevent effective engagement between parents, primary health care practitioners and other child care providers. The SCOPE Project was a collaborative intervention in the Western Australian (WA) primary care sector, focused on promoting healthier family lifestyles for parents of young children. The aim was to engage key stakeholders in the development of a robust plan for collaborative, feasible action that builds on existing services, uses consistent messages and strengthens service provider networks. The International Obesity Taskforce (IOTF) Planning Framework was used to provide key government and non-government stakeholders with an opportunity to participate in a systematic process to develop a plan of action for the promotion of healthy weight among young children. The project, in one rural and three urban communities in WA, involved stakeholders from 19 government and non-government organisations and 76 primary health care providers. The project began with a series of consultative forums, roundtable discussions and individual meetings with stakeholders and primary care providers in maternal and child health to identify current services in WA, as well as major barriers and potential approaches to improve collaboration. This process was informed by an international literature review, a modified Delphi study of Australian primary health care providers’ needs, and 36 focus groups with parents and child care providers across Australia, aimed at identifying promising interventions that enhance parent engagement and cross-sector collaboration in obesity prevention. Interventions were assessed against selection criteria agreed by participants including evidence or promise of effectiveness, feasibility and sustainability, as well as the capability to build on existing services, use consistent messages, strengthen collaboration and support service provider networks within WA. Stakeholders reached a unanimous decision to develop an online resource as an effective way for health professionals to engage and support pregnant women and first-time mothers. Fifteen focus groups and more than 100 interviews involving 168 pregnant women and parents of newborn children helped clarify what online information parents felt was most needed, how best this information could be delivered, and by whom. The results were used to perform a gap analysis of existing perinatal health websites to determine how the online resource could best meet user needs. The findings indicated that parents wanted smartphone apps with links to websites containing short, easy-to-read answers to everyday questions; information on events in their local area; links to further resources; and practical, personalised tools to assess and improve their nutrition, fitness and weight. The project’s output was the development of the Ngala Healthy You, Healthy Baby website and smartphone app (www.ngala.com.au/hyhb). This clinically endorsed, interactive online resource for pregnant women, first-time mothers and their providers builds on existing well-used Ngala services, with links to other service websites to promote consistent messages and strengthen service provider networks. The content and presentation provides pregnant women and mothers with a tool to track their weight (using a BMI calculator based on the Institute of Medicine recommendations), diet, physical activity, emotional wellbeing, social life and sleep patterns, and is tailored to the developmental stage of their child. It also provides tips on how to improve health and links users to relevant, quality assured information. Mothers can register to use the app and will receive e-mails tailored to their specific needs. The resources are promoted through the media and contact with health care provider services. The SCOPE project successfully implemented policy-making theory with key stakeholders, which included steps to increase their knowledge base; raise political will to support and generate resources for intervention; and promote a strategy for change by identifying priorities for action and developing a clear plan for implementation.4 Selection of population-wide interventions to prevent overweight and obesity requires consideration of ‘best available evidence’, including implementation issues, not just empirical evidence. This requires key stakeholders to come together to formulate a collaborative agreement on what is feasible, relevant and compatible, with the goal of building on current programs and networks rather than focusing on isolated researcher-developed interventions. The IOTF planning and decision framework builds on the portfolio approach to health promotion planning, with selection of programs based on best available evidence. Within the context of the SCOPE project, the IOTF framework provided a systematic approach that promoted increased collaboration and better co-ordination between primary healthcare providers for the prevention of early childhood obesity. A key success factor was the collaborative participation of senior policy makers and practitioners from the start of the project. Their participation led to considerable sharing of information, and their review and assessment of interventions against agreed criteria helped clarify: what action was relevant, feasible and effective (taking state and national priorities into account); organisational commitment and resource issues; and the likely readiness of practitioners and the community for translation into practice. Moreover, the development of a formal agreement between key stakeholder organisations resulted in strong cross-sector collaboration to ensure that with limited resources, the intervention could be sustained with consistent messages from all stakeholders.

Oral health interventions in Australian Aboriginal communities: a review of the literature

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed.