Sanjoti Parekh

Past, present, and future of ehealth and mhealth research to improve physical activity and dietary behaviors

Because physical inactivity and unhealthy diets are highly prevalent, there is a need for cost-effective interventions that can reach large populations. Electronic health (eHealth) and mobile health (mHealth) solutions have shown promising outcomes and have expanded rapidly in the past decade. The purpose of this report is to provide an overview of the state of the evidence for the use of eHealth and mHealth in improving physical activity and nutrition behaviors in general and special populations. The role of theory in eHealth and mHealth interventions is addressed, as are methodological issues. Key recommendations for future research in the field of eHealth and mHealth are provided.

A systematic review of the public's knowledge and beliefs about antibiotic resistance.

OBJECTIVES The objective of this study was to systematically review quantitative and qualitative studies on the publics knowledge and beliefs about antibiotic resistance. METHODS We searched four databases to July 2014, with no language or study design restrictions. Two reviewers independently extracted data. We calculated the median (IQR) of the proportion of participants who agreed with each statement and synthesized qualitative data by identifying emergent themes. RESULTS Of 3537 articles screened, 54 studies (41 quantitative, 3 mixed methods and 10 qualitative) were included (55 225 participants). Most studied adults (50; 93% studies) and were conducted in Europe (23; 43%), Asia (14; 26%) or North America (12; 22%). Some participants [median 70% (IQR 50%-84%); n = 8 studies] had heard of antibiotic resistance, but most [median 88% (IQR 86%-89%); n = 2 studies] believed it referred to changes in the human body. Many believed excessive antibiotic use [median 70% (IQR 59%-77%); n = 11 studies] and not completing antibiotic courses [median 62% (IQR 47%-77%); n = 8 studies] caused resistance. Most participants nominated reducing antibiotic use [median 74% (IQR 72%-85%); n = 4 studies] and discussing antibiotic resistance with their clinician (84%, n = 1 study) as strategies to reduce resistance. Qualitative data supported these findings and additionally identified that: participants believed they were at low risk from antibiotic resistance participants; largely attributed its development to the actions of others; and strategies to minimize resistance should be primarily aimed at clinicians. CONCLUSIONS The public have an incomplete understanding of antibiotic resistance and misperceptions about it and its causes and do not believe they contribute to its development. These data can be used to inform interventions to change the publics beliefs about how they can contribute to tackling this global issue.

Reproducibility of food and nutrient intake estimates using a semi-quantitative FFQ in Australian adults

OBJECTIVE To assess the reproducibility of a 135-item self-administered semi-quantitative FFQ. DESIGN Control subjects who had previously completed an FFQ relating to usual dietary intake in a nationwide case-control study of cancer between November 2003 and April 2004 were randomly selected, re-contacted, and invited to complete the same FFQ a second time approximately one year later (between January and April 2005). Agreement between the two FFQ was compared using weighted kappa statistics and intraclass correlation coefficients (ICC) for food groups and nutrients. Summary questions, included in the FFQ, were used to assess overall intakes of vegetables, fruits and meat. SETTING General community in Australia. SUBJECTS One hundred men and women aged 22-79 years, randomly selected from the previous control population. RESULTS The weighted kappa and ICC measures of agreement for food groups were moderate to substantial for seventeen of the eighteen food groups. For nutrients, weighted kappa ranged from 0.44 for starch to 0.83 for alcohol while ICC ranged from 0.51 to 0.91 for the same nutrients. Estimates of meat, fruit and vegetable intake using summary questions were similar for both survey periods, but were significantly lower than estimates from summed individual food items. CONCLUSIONS The FFQ produced reproducible results and is reasonable in assessing the usual intake of various foods and nutrients among an Australian adult population.

Living with diabetes: rationale, study design and baseline characteristics for an Australian prospective cohort study

BackgroundDiabetes mellitus is a major global public health threat. In Australia, as elsewhere, it is responsible for a sizeable portion of the overall burden of disease, and significant costs. The psychological and social impact of diabetes on individuals with the disease can be severe, and if not adequately addressed, can lead to the worsening of the overall disease picture. The Living With Diabetes Study aims to contribute to a holistic understanding of the psychological and social aspects of diabetes mellitus.Methods/DesignThe Living With Diabetes Study is a 5-year prospective cohort study, based in Queensland, Australia. The first wave of data, which was collected via a mailed self-report survey, was gathered in 2008, with annual collections thereafter. Measurements include: demographic, lifestyle, health and disease characteristics; quality of life (EQ-5D, ADDQoL); emotional well-being (CES-D, LOT-R, ESSI); disease self-management (PAM); and health-care utilisation and patient-assessed quality of care (PACIC). 29% of the 14,439 adults who were invited to participate in the study agreed to do so, yielding a sample size of 3,951 people.DiscussionThe data collected by the Living With Diabetes Study provides a good representation of Australians with diabetes to follow over time in order to better understand the natural course of the illness. The study has potential to further illuminate, and give a comprehensive picture of the psychosocial implications of living with diabetes. Data collection is ongoing.

Association between melanoma thickness, clinical skin examination and socioeconomic status: Results of a large population‐based study

Survival from melanoma is inversely related to tumour thickness and is less favorable for those in lower socioeconomic (SES) strata. Reasons for this are unclear but may relate to a lower prevalence of skin screening. Our aim was to examine the association between melanoma thickness, individual‐level SES and clinical skin examination (CSE) using a population‐based case‐control study. Cases were Queensland (Australia) residents aged 20–75 years with a histologically confirmed first primary invasive cutaneous melanoma diagnosed between January 2000 and December 2003. Telephone interviews were completed by 3,762 cases (77.7%) and 3,824 (50.4%) controls. Thickness was dichotomized to thin (≤2 mm) and thick (>2 mm). Compared with controls, the risk of thick melanoma was significantly increased among men [relative risk ratio (RRR) = 1.56, 95% CI = 1.22–2.00], older participants (RRR = 1.76, 95% CI = 1.10–2.82), those educated to primary level (RRR = 1.70, 95% CI = 1.08–2.66), not married/living as married (RRR = 1.47, 95% CI = 1.15–1.88), retired (RRR = 1.39, 95% CI = 1.01–1.94) and not having a CSE in past 3 years (RRR = 1.45, 95% CI = 1.12–1.86). There was a significant trend to increasing prevalence of CSE with higher education (p < 0.01) and the benefit of CSE in reducing the risk of thick melanoma was most pronounced among that subgroup. There were no significant associations between cases with thin melanoma and controls. Melanoma thickness at presentation is significantly associated with educational level, other measures of SES and absence of CSE. Public health education efforts should focus on identifying new avenues that specifically target those subgroups of the population who are at increased risk of being diagnosed with thick melanoma.

Improving diet, physical activity and other lifestyle behaviours using computer-tailored advice in general practice: a randomised controlled trial

BackgroundThe adoption and maintenance of healthy behaviours is essential in the primary prevention of chronic non-communicable diseases. This study evaluated the effectiveness of a minimal intervention on multiple lifestyle factors such as diet, physical activity, smoking and alcohol, delivered through general practice, using computer-tailored feedback.MethodsAdult patients visiting 21 general practitioners in Brisbane, Australia, were surveyed about ten health behaviours that are risk factors for chronic, non-communicable diseases. Those who completed the self-administered baseline questionnaire entered a randomised controlled trial, with the intervention group receiving computer-tailored printed advice, targeting those health behaviours for which respondents were not meeting current recommendations. The primary outcome was change in summary lifestyle score (Prudence Score) and individual health behaviours at three months. A repeated measures analysis compared change in these outcomes in intervention and control groups after adjusting for age and education.Results2306 patients were randomised into the trial. 1711 (76%) returned the follow-up questionnaire at 3 months. The Prudence Score (10 items) in the intervention group at baseline was 5.88, improving to 6.25 at 3 months (improvement = 0.37), compared with 5.84 to 5.96 (improvement = 0.12) in the control group (F = 13.3, p = 0.01). The intervention group showed improvement in meeting recommendations for all individual health behaviours compared with the control group. However, these differences were significant only for fish intake (OR 1.37, 95% CI 1.11-1.68), salt intake (OR 1.19, 95% CI 1.05-1.38), and type of spread used (OR 1.28, 95% CI 1.06-1.51).ConclusionA minimal intervention using computer-tailored feedback to address multiple lifestyle behaviours can facilitate change and improve unhealthy behaviours. Although individual behaviour changes were modest, when implemented on a large scale through general practice, this intervention appears to be an effective and practical tool for population-wide primary prevention.Trial RegistrationThe Australian New Zealand Clinical Trials Registry: ACTRN12611001213932

Spousal concordance and reliability of the ‘Prudence Score’ as a summary of diet and lifestyle

Objectives: This paper describes a composite ‘Prudence Score’ summarising self‐reported behavioural risk factors for non‐communicable diseases. If proved robust, the ‘Prudence score’ might be used widely to encourage large numbers of individuals to adopt and maintain simple, healthy changes in their lifestyle.

Exploring the use of technology pathways to access health information by Australian university students: a multi-dimensional approach.

Objective: Mobile wireless communication technologies (MWCT) and social media (SM) networks create pathways for accessing widely available information that are favoured particularly by younger generations. The purpose of this study was to explore the way university students use these communication technologies to access health information. Method: Participants (n = 696), who were recruited via an email invitation, completed an online self-reported survey that collected multi-dimensional data consisting of quantitative, qualitative and spatial statistics. Results: The results indicate that technology was used extensively to search for health information and resulted in positive changes in participants’ behaviours; however they perceived lack of reliability of the information as a pressing issue. Conclusion: The results suggest that appealing, persuasive and reliable MWCT and SM can be used extensively to promote health amongst Australian youth.

Self-assessed health status and neighborhood context

ABSTRACT In recent years, there has been growing interest in the relationship between the characteristics of neighborhoods and the health and well-being of residents. The focus on neighborhood as a health determinant is based on the hypothesis that residing in a disadvantaged neighborhood can negatively influence health outcomes beyond the effect of individual characteristics. In this article, we examine three possible ways of measuring neighborhood socio-economic status, and how they each impact on self-reported health status beyond the effect contributed by individual-level factors. Using individual-level data from the Household Income and Labor Dynamics Australia survey combined with neighborhood-level (suburb) data, we tested the proposition that how one measures neighborhood socio-economic characteristics may provide an important new insight into understanding the links between individual-level outcomes and neighborhood-level characteristics. The findings from the analysis illustrate that although individual-level factors may be important to understanding health outcomes, how one accounts for neighborhood-level socio-economic status may be equally important. The findings suggest that in developing place-based health programs, policy makers need to account for the complex interactions between individual drivers and the potential complexities of accounting for neighborhood socio-economic status.

Clinical and community advisory councils in primary health networks: from consultation to collaboration for action

Clinical and Community Advisory Councils in Primary Health Networks: From consultation to collaboration for action Sweatha Iyengar, Amanda Glenwright, Holly Brennan, Anar Ulikpan, PhD, and Sanjoti Parekh, PhD Abt Associates Pty Ltd, Brisbane, School of Public Health, The University of Queensland, Herston, Central Queensland, Wide Bay, Sunshine Coast PHN, Maroochydore, and Menzies Health Institute Queensland, Griffith University, Meadowbrook, Queensland, Australia