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Introduction: Appraising the quality of studies included in systematic reviews combining qualitative and quantitative evidence is challenging. To address this challenge, a critical appraisal tool was developed: the Mixed Methods Appraisal Tool (MMAT). The aim of this paper is to present the enhancements made to the MMAT. Development: The MMAT was initially developed in 2006 based on a literature review on systematic reviews combining qualitative and quantitative evidence. It was subject to pilot and interrater reliability testing. A revised version of the MMAT was developed in 2018 based on the results from usefulness testing, a literature review on critical appraisal tools and a modified e-Delphi study with methodological experts to identify core criteria. Tool Description: The MMAT assesses the quality of qualitative, quantitative, and mixed methods studies. It focuses on methodological criteria and includes five core quality criteria for each of the following five categories of study designs: (a) qualitative, (b) randomized controlled, (c) nonrandomized, (d) quantitative descriptive, and (e) mixed methods. Conclusion: The MMAT is a unique tool that can be used to appraise the quality of different study designs. Also, by limiting to core criteria, the MMAT can provide a more efficient appraisal.

Little research has assessed the fidelity, adaptation or integrity of activities implemented within community-based obesity prevention initiatives. To address this gap, a mixed-method process evaluation was undertaken in the context of the South Australian Obesity Prevention and Lifestyle (OPAL) initiative. An ecological coding procedure assessed fidelity and adaptation of activity settings, targets and strategies implemented in the second year of four communities. Implementation integrity reflected fidelity and adaptation to local context, whereas efforts resulting in significant deviations from the original plan were deemed to lack fidelity and integrity. Staff implemented 284 strategies in 205 projects. Results show that 68.3 and 2.1% of strategies were implemented with fidelity or adapted, respectively. Overall, 70.4% of all strategies were implemented with integrity. Staff experienced barriers with 29.6% of strategies. Chi-square analyses show statistically significant associations between implementation integrity and strategy type, intervention and behavioural targets. These relationships are weak to modest. The strongest relationship was found between implementation integrity and proximal target. Staff experienced implementation barriers at the coalition, policy, organization, interpersonal and community levels. The greatest range of barriers was encountered working with organizations. To overcome these barriers, staff took greater ownership, invested more time, persisted and allocated more financial resources.

Background: Early obesity prevention research interventions in Australia generally expect participants to be able to communicate in English, but do not account for other languages. This study aimed to investigate engagement, satisfaction, retention and behavioural outcomes of linguistically diverse participants from a mainstream early childhood obesity prevention trial. Methods: Healthy Beginnings is a nurse‐led intervention based in Sydney, supporting families with optimal infant feeding and active play via telephone. This secondary analysis assessed participant engagement in the nurse telephone calls (call completions), satisfaction and behavioural outcomes (6‐ and 12‐month survey data) and retention (survey completions), in the first year of life according to participants' language spoken at home (English or other language). Results: Of 1155 mothers, 533 (46%) spoke a language other than English at home. Significantly fewer mothers speaking a language other than English completed the 6‐month survey (79%) compared to those speaking English (84%), yet mothers speaking a language other than English who completed the program were more satisfied with the program overall. Significantly fewer mothers speaking a language other than English completed the final four nurse calls (of six) (56%‐65%) compared to those speaking English (70%‐80%). Adjusted odds ratios showed selected behavioural outcomes were significantly more positive for participants speaking English at home. Conclusions: Healthy Beginnings trial participants who spoke a language other than English at home had less favourable engagement, retention and behavioural outcomes compared to those who spoke English. So what? Early obesity prevention interventions should consider cultural adaptations to improve engagement and effectiveness among culturally and linguistically diverse families. [ABSTRACT FROM AUTHOR]

Objective: To evaluate population‐level implementation of Confident Body, Confident Child (CBCC); an evidence‐based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2‐6 years; with community child health nurses (CHNs). Methods: This study utilised an implementation‐effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre‐ and post‐intervention delivery to CHNs, respectively. Results: Twenty‐six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1‐day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non‐significant improvements in CHN knowledge (P =.077) and attitudes towards overweight (using Anti‐Fat Attitudes scale; significant improvements on willpower sub‐scale only (P <.05)). Discussion: This is the first study to evaluate population‐wide CBCC implementation in a real‐world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation‐focused methodologies to translate preventive eating disorder programs into community child health services. [ABSTRACT FROM AUTHOR]

Issue addressed: This study aimed to analyse the relationship between peer‐delivered health promotion programmes and student well‐being and to expand the limited body of research examining peer‐to‐peer mental health promotion as experienced by student leaders. Methods: The study was cross‐sectional and focused on the experience of participants of a Sydney‐based University Mental Health Day event, including student leaders, student participants, university staff and industry partners. It adopted a mixed‐method approach to data collection, including a quantitative and a qualitative phase. Results: Results from the quantitative phase demonstrate the benefits of peer‐delivered health promotion programmes to students who receive the event. Results from the qualitative phase of the study provide a deeper insight into the delivery of the event, from both a student leader perspective, and also from the perspective of other stakeholders, who worked closely with student leaders. Two main themes emerged from the qualitative material and are explored in detail: enabling leadership and creating a sense of purpose. Conclusion: The study concludes that, while there is mounting evidence of the benefits of student‐led mental health programmes for both leaders and their peers, more research needs to be carried out to better understand how to optimise these experiences and unlock their full potential with reference to student mental health. So what?: With the ongoing pressure on university student services to support student well‐being not being met with appropriate resourcing, peer‐to‐peer programmes, like the Mental Health and Well‐being Student Ambassador Programme, have a real opportunity to make strides in supporting and promoting student mental health. [ABSTRACT FROM AUTHOR]

Issue addressed: Poor sleep quality is common among university students and can have negative implications for physical, emotional, cognitive and academic wellbeing. Previous research has identified that sleep beliefs and sleep behaviours are associated with poor sleep quality. However, few studies have examined these variables simultaneously. This study explored associations between dysfunctional beliefs about sleep, sleep hygiene and sleep quality in a sample of university students. Methods: Participants were recruited from a pool of undergraduate psychology students and included 120 male students and 145 female students with an average age of 20 years (SD = 5.10). Participants completed an online survey including the Pittsburgh Sleep Quality Index, Dysfunctional Beliefs and Attitudes About Sleep Scale, Sleep Hygiene Index and demographic items. Results: Overall 60.4% of participants (59.4% of women, 40.6% of men) had poor sleep quality. Logistic regression indicated a significant positive association between sleep hygiene and sleep quality, OR = 1.16, P >.001, 95% CI (1.10, 1.23), and no significant relationship between dysfunctional beliefs about sleep and sleep quality, OR = 1.03, P >.79, 95% CI (0.84, 1.26), after adjusting for covariates. Conclusions: Sleep interventions for university students are needed and could focus on common hygiene components, such as using the bed for activities other than sleeping, engaging in arousing activities before bed and how to manage thinking and worrying before bed. So What? The results of the study demonstrate poor sleep quality is common among university students and indicates that sleep interventions are warranted. The positive association found between sleep hygiene and sleep quality highlights that interventions should focus on behavioural components of sleep. [ABSTRACT FROM AUTHOR]

Issue addressed: Ethical values underpin the health promotion discipline and profession, and competencies required for professional practice. Understanding how ethical values are translated into professional practice is critical. The aim of this exploratory sequential mixed methods study was to explore Australian health promotion stakeholder perspectives about ethical health promotion practice. Methods: A face‐to‐face group‐based workshop (n = 15), online survey (n = 77) and in‐depth individual interviews (n = 15) collected qualitative and quantitative data from health promotion stakeholders. Descriptive statistics were used to analyse quantitative and thematic analysis to analyse qualitative data. Results: Tensions emerged regarding the nomenclature of ethical health promotion practice, with ethics framed largely by participants as related to formal approval for research. A range of barriers and enablers to ethical practice were identified. Barriers related to obtaining ethical approvals and working with specific population groups and communities. Enablers included professional development opportunities, access to a specialised human research ethics committee and a better understanding of what is meant by 'ethical practice'. Conclusion: Findings suggest the need for an ethical health promotion practice framework and resources for practitioners and organisations throughout Australia. We propose a framework comprising two pillars: (a) developing critical practice; and (b) building the evidence‐based for health promotion. So what?: This study recognises the need for increased dialogue about the ethical foundations of health promotion. The development of a health promotion ethics framework can better support the development of ethical practice in the Australian health promotion discipline and profession. [ABSTRACT FROM AUTHOR]

Introduction: The Active Kids voucher is a universal, state‐wide voucher program, provided by the New South Wales (NSW) Government, Office of Sport. All school‐aged children in NSW are eligible to receive a voucher to reduce registration costs of structured physical activity programs. This study explores reasons behind lower uptake among children who are overweight or obese, from cultural and linguistically diverse families and those living in low socio‐economic areas. Methods: Participants were recruited through a convenience sample of parent/carers who participated in the NSW Health Go4Fun program. Qualitative data were collected using focus groups. The Framework method was adapted for the analysis, taking an interpretive phenomenological approach. Results: Study participants (n = 54) were all parents of children who were overweight or obese from both low and high socio‐economic status (SES). Most reported speaking a primary language other than English at home (65%). Parents were mostly aware of the Active Kids program (91%) and reported that the voucher had a positive impact on their children's participation in structured physical activity. A range of socio‐ecological factors, in addition to activity cost, influenced whether parents were able to use an Active Kids voucher and participate in structured physical activity. Conclusions: The Active Kids voucher does not alleviate all barriers, particularly for families living in low socio‐economic areas. Engagement of this population in structured physical activities using the Active Kids vouchers could be strengthened through the implementation of effective interventions which comprehensively address the remaining barriers, such as access and flexibility of programs with local stakeholders and activity providers. [ABSTRACT FROM AUTHOR]

Issue addressed: To describe the need for high school sleep education from the perspective of undergraduate university students. Methods: Undergraduate students who completed an online course on sleep and circadian health were surveyed 6 months after course completion. Students were asked whether a similar course would have benefited them as high school students, and about the need for sleep education in high schools. Thematic analysis of this qualitative data was carried out. Results: Eighty‐nine students who had attended 71 unique high schools provided responses. Eight‐one per cent thought they would have benefitted from a similar course during high school and identified domains of sleep knowledge particularly relevant to high school students. They cited environmental barriers to healthy sleep present during high school and believed that sleep education could improve students' lifestyle, sleep and performance. Nineteen per cent of students said they would not have benefited, because they perceived sleeping patterns during high school to be nonmodifiable or believed that previous sleep education was sufficient. Of the respondents who did not think students would benefit, 53% would still tell their high school principal that there was a need for sleep education. Conclusions: The findings support the need for engaging sleep education for high school students. Future studies should examine the perspectives of students in high school directly, rather than undergraduate students who have already shown an interest in sleep health. So what?: Sleep health is missing from the Australian school curriculum. Online courses may be an engaging method of promoting sleep and circadian health to high school students. [ABSTRACT FROM AUTHOR]

Issue addressed: The health benefits for children of regular physical activity (PA) are well documented. This study examined relationships between organised sport participation in multiple settings and child and household‐level characteristics. Methods: Using a general population survey of Queensland children's health and lifestyle characteristics, participation in organised sport was examined in (a) club settings, (b) club‐based team and individual organised sport settings and (c) school settings. The association between organised sport participation in these settings and meeting the Australian PA guidelines was also considered. Results: Organised sport participation prevalence was 46% (both school and club settings), 16% (club sport only), 20% (school sport only) and 18% (neither setting). Multivariable logistic regression analysis indicated participation in one setting increased the odds of participation in other settings, exclusive participation in individual sport decreased the odds of school sport participation and organised sport participation was not associated with meeting recommended PA guidelines for children. Conclusions: The study highlights areas where the contribution of organised sport to PA more broadly could be strengthened. Organised sport participation, however, was not sufficient to meet the child PA guidelines. The home environment, availability of parents and guardians and PA opportunities in other settings, such as school, free time and active transport, are as important to increasing children's PA levels. So what?: While organised sport is an important component towards meeting PA guidelines, PA policy and program development should consider strategies to encourage PA in other settings to help children achieve health‐enhancing levels of PA that are sustained into adulthood. [ABSTRACT FROM AUTHOR]

Issue addressed: Internationally, universities have recognised the benefits of Pet Support Programs (PSPs). However, existing literature has predominately focused on quantitatively measuring health outcomes associated with a PSP amongst student populations. This research aimed to explore the feasibility of a PSP within an Australian university, as there is a need to explore practical considerations involved in implementation. Methods: This research used a qualitative descriptive approach. Participants were recruited via purposive snowball sampling. The sample included 17 participants across eight administrative divisions within an Australian university. Semi‐structured individual interviews were used to collect data. Data were analysed using thematic analysis. Results: Three main themes emerged from the data: Organisational Change, Program Management and Perceived Outcomes. Findings suggest several considerations from both an organisational and program level that need to be addressed prior to implementation, including the university's policies, the location and animal welfare. The main perceived outcomes were stress relief and social support. Ways to minimise risks to those who may have an aversion towards animals were also discussed. Conclusions: Participants believed implementing a PSP would be feasible in the university setting, provided all aforementioned considerations were adequately addressed. Considerations identified have the potential to act as a barrier or a facilitator depending on how they are managed. So what?: Where feasible and later implemented, a PSP could provide Australian university students and staff with an alternative means of improving mental health, providing stress relief and contributing towards the Health Promoting University framework. [ABSTRACT FROM AUTHOR]

Issues addressed: The significant investment in health research has resulted in an increased focus to determine suitable approaches to measure health promotion research impact. This research was undertaken at the request of a nationally competitive research organisation that funds health promotion research, to explore how Chief Investigators (CIs) on their funded projects understood research impact, its measurement and associated challenges. Methods: Participants were required to be or have been a CI on an Australian competitive research (exploratory or intervention) grant focussed on health promotion. The qualitative study used thematic analysis from one‐on‐one interviews. Themes were created and descriptive quotes were selected to illustrate the main findings. Results: The majority of participants were female (n = 13) working at a university (n = 13). Three themes emerged: a) defining health research impact; b) complexity and simplicity of measuring health research impact; c) challenges of measuring health research impact: i) differing language; ii) differing assessment; iii) attribution and timing; and iv) resourcing and skills. Conclusion: Researchers recognised that there are significant challenges in measuring the impact of health promotion research. The most significant factors identified by participants were the disciplinary background of the researchers undertaking the measurement, their skills and experience and the resources (including time) available to assess impact. So what?: Research impact assessment is complex, time consuming and requires specific skills to facilitate measurement of impact provision of funding for this activity in research grants and research impact training is required. [ABSTRACT FROM AUTHOR]