Developing and Evaluating Complex Interventions 5-day training course – registrations open!

Developing and Evaluating Complex Interventions 5-day training course run by Public Health Insight and DECIPHer.

Introducing a brand new 5-day intensive training course, run by our team from Public Health Insight and colleagues from DECIPHer from Cardiff University. Register for this training course here: http://ecommerce.mdhs.unimelb.edu.au/product.asp?pID=258&cID=89&c=24346

Children and Youth with Obesity—a growing global epidemic

Cochrane Child Health

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According to the US Centers for Disease Control (CDC), obesity has more than doubled in children and quadrupled in adolescents in the last 30 years.1 In 2012, more than a third of children and adolescents in the US were overweight or obese.1 Obesity is not limited to developed countries or older children, the World Health Organization (WHO) estimated that in 2013, 42 million children under the age of 5 years were overweight and close to 31 million of these children were living in developing countries.2 The global nature and steady increase has led the WHO to declare childhood obesity as “one of the most serious public health challenges of the 21st century.”2

Obesity can have wide ranging effects both in the short-term and long-term. In the short term, it can affect social, psychological and physical health. For example, children and adolescents with obesity are more…

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The Teeth Tales Showcase: The Finale to an 8 year community-based oral health research study

Written by Research Fellow Dana Young

My role for the most part of the last 4 years has been implementing a child oral health promotion intervention for children from a migrant and refugee background, also known as Teeth Tales. Although the inception of the project began many years before my involvement, I was involved with rolling out the exploratory trial phase of study.

The idea for the Teeth Tales research study arose in 2006 due to community concerns for the oral health of children from a refugee or migrant background residing in the Moreland and Hume local government areas (LGAs) of Melbourne. From this a PhD study(1) exploring the sociocultural influences on oral health was developed and conducted in partnership with Arabic Welfare, Victoria Arabic Social Services and Pakistani Australia Association of Melbourne to discuss these issues with mothers from a Lebanese, Iraqi and Pakistani background. Based on the findings from this initial work the next phase of Teeth Tales was designed and piloted to explore the implementation of a community based child oral health promotion intervention for children from a migrant and refugee background (2). For more background information about the Teeth Tales study visit out website here.

The Teeth Tales study has been an 8 year project led in partnership between Merri Community Health (MCHS) and The University of Melbourne and was culminated through a showcase on the 23rd of October 2014. This half day event involved members of the key partner agencies involved in the project, which alongside MCHS and the University of Melbourne include Dental Health Services Victoria, Moreland City Council, Arabic Welfare, Victorian Arabic Social Services, Pakistani Australia Association of Melbourne, The Centre for Culture, Ethnicity and Health and North Richmond Community Health Service. Key findings from the research were presented and representatives from the partner organisations presented their experiences and learnings associated with being involved in the Teeth Tales study.

Mandy Truong presenting at the Teeth Tales Showcase October 2014

Mandy Truong presenting at the Teeth Tales Showcase October 2014

This research project provided 667 children with a community based dental screening. For many children this was the first time they had seen a dental professional. Twelve percent of these children were referred on for further treatment at a dental clinic. Parents allocated to the intervention group received education from trained peer educators around the Dental Health Services Victoria key oral health messages of ‘Eat Well, Drink Well, Clean Well and Stay Well’. Based on earlier findings the discussion of traditional oral health practices was incorporated into the peer education oral health course. Results indicate the Teeth Tales intervention increased the oral hygiene practices of the participants, which is very important for the prevention of oral health problems.

Outcomes from the Teeth Tales study were applicable for not only the families involved as study participants but also for the multiple partner organisations involved. Working in partnership with established cultural organisations is critical to health promotion initiatives for families with migrant and refugee backgrounds. The Teeth Tales showcase was an exhibit of the wonderfully strong organisational partnerships that have been created and maintained over the life of the project and how involvement in the project has forged links between the local organisations and potential clients in the community. There was unanimous feedback from the partner organisations that this project had provided them with an opportunity to promote additional health and social service support to participants. Data collection sessions, where children received a free dental screening, were seen as an ideal opportunity to provide this information. One organisation arranged for families to attend appointments at the time data collection sessions were being run to alleviate travel demands on the families to their organisation. Findings from the study will also contribute to the updated Dental Health Services Victoria clinical guidelines for dental clinicians and maternal child health nurses.

It has been extremely rewarding working as a researcher involved with this study. I have developed my skills working with culturally diverse communities in a culturally appropriate manner, undertaken community and stakeholder engagement and liaised between participants and local services; whilst also witnessing the capacity of the cultural partner organisations grow to promote preventative health messages and to be able to aid migrant families to navigate the community health sector. Links have been created between culturally specific social services organisations, community health and the child and family services at local council – which will be of ongoing benefit for newly arrived families trying to access a multitude of services for their family.

For access to resources developed for the Teeth Tales study please visit the relevant organisations websites.

  • The Teeth Tales Peer Education Manual includes class materials for child oral health peer education trainers. You can access it from the Merri Community Health Services Website http://mchs.org.au/research-partnerships/latest-research. For more information, email Maryanne Tadic at maryannet@mchs.org.au
  • The Cultural Competency Organisational Review (CORe) Tool documents will be available via the The Centre for Culture, Ethnicity and Health website soon at ceh.org.au

References:

  1. Riggs E. Addressing child oral health inequalities in refugee and migrant communities. 2010.
  2. Gibbs L, Waters E, de Silva A, Riggs E, Moore L, Armit C, et al. An exploratory trial implementing a community-based child oral health promotion intervention for Australian families from refugee and migrant backgrounds: a protocol paper for Teeth Tales. BMJ open. 2014; 4 (3): e004260.

Our First Beyond Bushfires Symposium

The Beyond Bushfires Symposium was an all-day event held at the University of Melbourne on the 30th October, 2014. It provided an opportunity for the study investigators to present and discuss our preliminary findings with participants and community members as well as service providers and representatives from government. I really valued the engagement leading up to the event, on the day and the feedback that we received afterwards. Leading up to the big day there was so much interest, and with the 140 seat room booked out we had many people discuss their interest in the study and perspectives on the findings.

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Professor Elizabeth Waters introduces the academic team at the Beyond Bushfires Symposium October 2014

We had a full agenda that included presentations on social networks, diverse responses and reactions, couples, families and children, psychological outcomes, anger, bereavement, relocation, and separation during and immediately after the fires. The day was packed with information that was quite overwhelming in terms of scope and depth. The surveys gave a sense of the extent and pattern of impacts on individuals and communities, and the in-depth interviews gave a sense of the personal and individual experiences that people went through. Lesley Bebbington, local resident and youth worker, shared her heartfelt, emotional and extremely personal journey over the last five years. We felt that hearing from someone who had personally experienced the bushfires gave an insight into the impacts it has on one person’s life before we went on to discuss the broader, population impacts of the bushfires.

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Full house at the Beyond Bushfires Symposium October 2014

The Symposium brought together study partners and community members to discuss their views on the research and its importance for everyone involved. This dialogue provided an insight into the extraordinary input by multiple parties throughout the study, including consultations with community members/groups, local and state service providers and government departments from planning and designing the study, to interpreting results. The large contribution to discussions and debates regarding different aspects of our findings was incredible and really fulfilled our aim for the day. You could feel the passion and emotions being expressed from those who our findings have direct influence on. The interactive sessions provided great insight into future directions and issues of interest to local bushfire affected communities.

Some people within the audience were interested in the study methods and conclusions and who was involved in forming these conclusions. Additionally, there were discussions around what we hadn’t included within the study and we acknowledge that we couldn’t include everything and we had difficulties in making decisions regarding inclusions. But there is a large amount of research being undertaken in this area, and we hope that others can cover the important components that are beyond the scope of our study.

A few community members were worried about their emotions and possible distress that could result, and showed great courage in attending the day. I’m so glad these people attended after their contributions to our study, the symposium gave us a chance to feedback our findings and get responses and inputs for future considerations. The Symposium was also a chance for us to thank everyone who has supported the research, and gave us an avenue to share bushfires experiences, and learnings to inform service providers and state level organisations.

Associate Professor Lou Harms presenting at the Beyond Bushfires Symposium October 2014.

Associate Professor Lou Harms presenting at the Beyond Bushfires Symposium October 2014.

If you would like to keep informed of the research, please email info-beyondbushfires@unimelb.edu.au with the subject line “Add to mailing list” and you will receive updates on our project, including access to the presentations on the day, once they become available. Additionally, visit our website to access the latest findings and publications www.beyondbushfires.org.au


KT for Researchers: A New Training Course

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Knowledge translation and exchange (KTE) is becoming an area of research interest in Australia. Decision-makers are increasingly considering how they can engage with a range of sources of evidence. Consequently, calls for new research are accompanied with a need to … Continue reading

Lava grey and antique cream: the diaspora of health research.

It may appear to the outsider that the world of health research consists of a homogenous collective of nerdy academics crunching numbers in an attempt to answer scientifically important questions. But for those of us living in that world there sometimes arises occasions that throw into stark relief the contrasting dynamics at play amongst our own peers.

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Source: thebillproject.org

This realisation came to the fore this week during the formalities of the annual Royal Australasian College of Physicians Victoria Trainee Research Awards. I was lucky enough to have my abstract, which recounts my research on child health in same-sex families, selected to present in the Paediatric division. I had made the somewhat bold decision to present the entirety of my PhD in the very strict 12 minute time restriction, but having twice competed in the 3 Minute Thesis competition 12 minutes seemed like a luxury!

On arrival I flicked through the program for the evening and straight away knew it would be an interesting night. My sole-author paper immediately contrasted with all the other abstracts which contained lists of authors as long as your arm. They were jam packed with p values and confidence intervals and had long complex words like sarco-osteoporosis or bamboozling molecular markers such as FLT-3. I was entering a room full of clinicians and lab-based researchers who knew that black is black and white is white. My mixed methods approach, drawing heavily on the social sciences, allowed black to be lava grey and white to be antique cream. It was going to blow some minds.

The presentation itself went well. I kept to time and handled the slightly predictable questions comfortably: “aren’t the parents better educated and earn more money”; “but don’t all children have to deal with bullying of some sort”. As the marks for each presentation were collated a panel discussion on ‘advanced training and research’ re-emphasised the focus on clinical work. One participant even suggested that being a clinician made you a better researcher and that good researchers do better clinical work. It’s over 5 years since I’ve seen a real patient!

In this clinical world it was a little surprising therefore that I discovered I had won the Paediatric prize. It may have been somewhat of a euphemistic win (if such a thing is possible) as the comments included: “weren’t your slides pretty” and “good on you for having the guts to use a different methodology.” Perhaps throwing words like post-positivism, social constructivism, queer theory and heteronormativity out at the audience did the job of impressing and confusing in equal measure. Putting all modesty aside it is more likely that the judges recognised the originality of my research and the efforts required to pull together the tricky mixed methods that I had had the ‘guts’ to use.

Mixed methods

While I am proud of the award, and proud that the college was able to recognise my work, I was reminded that there is a huge gulf between the more social perspectives of health, and public health in general, and the way in which many clinicians often think. As I continue my research, drawing on the social determinants of health, this illuminating night acts as an important reminder that we need to continually engage with our clinical partners to ensure that all the multidimensional aspects of health and wellbeing are brought to bear in our efforts to improve the health of the whole population.

I would like to thank Elizabeth Waters and Ruth McNair who have supervised my research, the Advisory Committee who allowed the development of a robust mixed methods framework and the whole of the Jack Brockhoff Child Health and Wellbeing Program for their advice and support.

Dr Simon Crouch, Honorary Research Fellow and Lead Investigator, The Australian Study of Child Health in Same-Sex Families

Promoting inclusive research with families: A visit to the Peninsula Cerebra Research Unit in Exeter, UK

I had the opportunity to recently visit the Peninsula Cerebra Research Unit (PenCRU), which is based within the Peninsula Medical School, at the University of Exeter in the UK. PenCRU is funded by the charity Cerebra and focuses on Childhood Disability Research. Over the last five years PenCru has evolved the practice of involving families in all stages of their research. This ensures that research is relevant to improving the health and wellbeing of disabled children and their families. It is also worth noting that in the UK it is mandatory to involve patients and members of the public in research when applying for government sponsored funding streams. The aim of my visit to PenCRU was to learn about the practice of involvement and how partnerships were formed between researchers and the local families.

As an early career research fellow working in the area of childhood disability, and having a passion for engaging with families, the concept of involvement was not necessarily something new. Our Program always ensures parents and carers have the opportunity to sit on advisory groups, and that their perspectives are captured within the research design if the research we do concerns them. However, after spending time at PenCRU and talking with the parents that they worked with, the concept of involvement demonstrated a more profound meaning to me.

PenCru have established a Family Faculty, where families (most often, mothers) who have an interest in being involved in research will participate in various activities with researchers. A lot of work was done in the early stages to encourage families to get involved, such as holding forums, websites, newsletters and launch events. To date there is over 200 families in the Family Faculty database. There is no formal structure to this involvement; parents can join in at any stage of the research process whether this is identifying important issues that research needs to address, actually formulating research questions or prioritising those questions for funding applications. Families can assist in the design of research, writing of summaries and grants and also finding sources of funding through support services and charities they know of. Members of the Family Faculty are consulted on all research ideas or queries that come to PenCru to see if there is sufficient interest to explore the topic and shape into a research question that is meaningful to families.

I managed to spend a good amount of time with four of the parents on the Family Faculty who felt empowered in their roles with researchers and that this opportunity enabled them to have a voice and share their life experiences in an informed way. They enjoyed having the choice to be involved in projects that interested them the most and attending meetings when it was convenient for them in their caring role. This really felt like a partnership that worked respectfully and fruitfully for both the parents and the researchers.

My own take away message from PenCRU was to think of involvement as a core research activity and one that is flexible, it is not something that can be allotted a particular research stage. To simply start by communicating widely to families about the work that we do, and to encourage families to share their views will be good starting point.

The Peninsula Cerebra Research Unit is part of the Peninsula Collaboration for Leadership in Applied Health Research and Care (PenCLAHRC). PenCLAHRC is a collaboration of Universities and NHS organisations in the South West of England which aims to deliver high-quality health research that influences medical practice, ensuring that research addresses issues that are relevant to patients and carers and results in beneficial new treatments and services. 

Read more at http://www.pencru.org/aboutus/#GCial3kPGMX4JIEc.99

Written by: Kim-Michelle Gilson