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Early childhood education (ECE) and development is internationally recognised as important to child health and wellbeing and to enabling children to become healthy productive adults. This paper analyses Australian ECE policy current in 2019. It uses the institutional framework of ideas, actors and institutions to determine the extent to which ECE policy recognises and acts on social determinants of health and health equity. We found that the policies supported integrated approaches, intersectoral collaboration and partnerships with parents and families. Evidence was important in formulating the ideas underpinning ECE policy. ECE was widely recognised as a social determinant of health, and the impacts of other social determinants of health and health equity were acknowledged. The ECE policies tended to be future-focused and not respond to social determinants that influence children and their families in the present time. The policies lacked strategies to address social determinants, or to engage with other sectors for this purpose. While some policies focused on breaking the cycle of disadvantage, they did not explore potential policy responses to pathways from intergenerational disadvantage to reduce poverty. Despite this, Australian ECE policy has achieved significant coherence, with shared understandings of the purpose and benefits of ECE.

Objectives Aesthetic services can pose a potential risk of infection to clients if instruments are not discarded or reprocessed after each use. Public health inspectors (PHIs) inspect personal service settings (PSS) to monitor compliance with infection prevention and control (IPAC) requirements. This study aimed to assess the prevalence of various IPAC infractions in Ontario PSS that were identified during routine compliance inspections and whether these were similar to those identified during investigations in these settings in which an IPAC lapse was deemed to exist. Methods PSS inspection results were analyzed from three public health units (PHUs) in Ontario in 2018. Premises were grouped into three premises types (hairdressing/barbering, aesthetics, and body modification) and infractions from 16 IPAC compliance categories were compared. Results of IPAC lapse investigations for all of Ontario were also compared across premises types. Results There were 5,386 inspections conducted in 4,483 PSS by three PHUs in 2018. PSS offering aesthetics were most likely to have infractions identified. Common infractions were related to inappropriate reuse of single-use and reusable instruments. Of the 121 IPAC lapses reported by PHUs in 2018, 52 (43.0%) were in PSS, and 73.1% of these were associated with nail salons/spas. Conclusions Operators could benefit from increased awareness of infection control best practices and the potential for infections to occur if these are not followed. PHIs could consider an alternate frequency of PSS inspection to increase operator education and compliance with minimum IPAC requirements.

The education of the future health care workforce is fundamental to ensuring safe, effective, and inclusive patient care. Despite this there has been chronic underinvestment in health care education and, even though there is an increased need for educators, the true number of medical educators has been in relative decline for over a decade.In this paper, we focus on the role of doctors as medical educators. We reflect on the culture in which medical education and training are delivered, the challenges faced, and their origins and sustaining factors. We propose a re-framing of this culture by applying Maslow's principles of the hierarchy of needs to medical educators, not only as individuals but as a specialist group and to the system in which this group works, to instigate actionable change and promote self-actualization for medical educators.Promoting and supporting the work of doctors who are educators is critically important. Despite financial investment in some practice areas, overall funding for and the number of medical educators continues to decline. Continuing Professional Development (CPD) schemes such as those offered by specialised medical education associations are welcomed, but without time, funding and a supportive culture from key stakeholders, medical educators cannot thrive and reach their potential.We need to revolutionise the culture in which medical education is practised, where medical educators are valued and commensurately rewarded as a diverse group of specialists who have an essential role in training the health care workforce to support the delivery of excellent, inclusive health care for patients. By reimagining the challenges faced as a hierarchy we show that until the fundamental needs of value, funding and time are realised, it will remain challenging to instigate the essential change that is needed.

Globally health promotion has remained marginalized while biomedical health systems have maintained and even increased their dominance. During 2019-2021 we drew on the local and historical knowledge of actors from multiple sectors through semi-structured interviews and focus groups, to assess the implications of the withdrawal of the state from health promotion in a suburban region of South Australia. Institutional theory enabled in-depth analysis of the ideas, actors, and institutional forces at play in the institutional field, and how these elements come together to maintain the dominance of medicine. We found that the ideas, actors and institutional forces supporting health promotion in the study region have weakened and fragmented. This has happened as biomedicine has increased its dominance in the region's health system, mirroring international trends. The results point to a withdrawal of state and federal governments from health promotion, which has led to severe gaps in leadership and governance, and locally, to a decline in capacity and resources. The state health department reallocated resources to focus on individual behavioural change rather than more structural factors affecting health. While some activities aimed at the social determinants of health or community development strategies remained, these had minimal institutional support. The establishment of a state government wellbeing agency in 2020 prompted an exploration to determine whether the agency and the international wellbeing movement presents an opportunity for a revival of more comprehensive health promotion.Health promotion has a rich history in South Australia. However, since government withdrew funding and institutional support, health promotion has become increasingly fragmented, unco-ordinated and targeted towards individual behaviour change activities. Analysis of the role of ideas, actors, and institutional forces, such as government policies, found that biomedical approaches to health and health care increasingly dominate the health system and health policy environment in the state and Australia wide. The establishment of a state government wellbeing agency in 2020 prompted optimism from participants that the government may once again take a leadership role in reviving health promotion and prevention strategies.

Objectives for Phase II of NASA’s Artemis Program include establishment of lunar surface infrastructure to support a sustainable, long-term human presence on the Moon. Terrestrially, awareness of climate impacts from cement and concrete production has led to renewed interest in traditional building materials using earthen and pozzolanic binders with locally sourced aggregates [1, 2, 3]. In remote, austere and resource-constrained environments, use of site-sourced materials is often an economic necessity in addition to being valuable for local autonomy and self-sufficiency. This study evaluates modifications to ASTM cement mortar testing methods, incorporating details from European standards for earthen plasters and lime-based mortars. Development of consistent, simplified methods for evaluating in-situ materials will be essential not only for meeting future climate goals and sustainable construction needs, but also for conducting autonomous robotic manipulation and evaluation of regolith construction materials. Introduction: Recent studies of in-situ derived simulant-based building materials for construction on the surface of the Moon and Mars have drawn on traditional building techniques and their renewed use in sustainable construction [4, 5]. Humans have experience spanning millennia building with site soils and locally-derived mineral materials. In addition to examples found at archaeological sites and historic buildings surviving to the present, some earthen building traditions (adobe, mud plastering) continue to be practiced to this day [6, 7], while others are seeing broader adoption in innovative construction techniques using 3D printing [8, 9]. In this study, a selection of these formulations were adapted for use with planetary analog site soils to assess the suitability of these methods in evaluating potential regolith construction materials for in-situ construction on planetary surfaces [10]. These studies focused on curing and compressive strength testing of preliminary mix formulations using small mortar specimens in ambient conditions. Materials Testing Methods for Mortars and Extruded Materials: Basic evaluations of soil-based building materials begin with particle size distribution and compressive strength. In North America, these assessments are often conducted following ASTM C-109, “Standard Test Method for Compressive Strength of Hydraulic Cement Mortars (Using 2-in. or [50 mm] Cube Specimens)” [11] in conjunction with ASTM C-144 (Standard Specification for Aggregate for Masonry Mortar) [12] and ASTM C-136 (Standard Test Method for Sieve Analysis of Fine and Coarse Aggregates) [13]. Key details of ASTM C109 requiring submersion of specimens in water during curing preclude its use with non-cementitious binders. Techniques used in evaluation of traditional clay plasters (DIN 18947) [14], lime mortars (EN 1015) [15] and pozzolanic materials were adapted here for use with specimens prepared from construction site mixes using local soils, industrial byproducts, organic additives and bagged materials from masonry and ceramic suppliers. Key Findings & Opportunities: Drawing upon European standards for traditional building materials and sustainable building products to modify ASTM methods can enable study of site-sourced, minimally-processed non-cement materials for terrestrial and planetary surface construction. Experience in refining these methods alongside researchers in sustainable construction demonstrates that: 1) tradespeople and craft builders in traditional construction have a valuable contribution to offer to the study of materials for in-situ construction on planetary surfaces, and 2) that development of consistent, simplified methods for use in preliminary testing of varied simulant and in-situ soil formulations for construction may enable opportunities for interdisciplinary collaboration with mutual benefits for terrestrial sustainable building and in-situ regolith construction on the Moon and Mars. References: [1] Delinière, R., Aubert, J. E., Rojat, F., & Gasc-Barbier, M. (2014). Physical, mineralogical and mechanical characterization of ready-mixed clay plaster. Building and Environment, 80, 11-17. [2] MacDougall, C., & Vardy, S. (2014). Mechanical performance of lime-cement mortar for straw-bale construction. Journal of Green Building, 9(3), 100-115. [3] Seitz, S., Haynes, R. & Glass, B. “Playing With DIRT: Building the Framework for a Comprehensive Materials Database.” ASCE Earth & Space 2022 Conference, Denver, Colorado. [4] Rosa, I., Coto, A., Allende, M. I., Lepech, M. D., & Loftus, D. J. (2021). Designing Biopolymer-Bound Regolith Composites for Maximum Compressive Strength. Earth and Space 2021, 200-214. [5] Karl, D., Duminy, T., Lima, P., Kamutzki, F., Gili, A., Zocca, A., Günster, J. and Gurlo, A., 2020. Clay in situ resource utilization with Mars global simulant slurries for additive manufacturing and traditional shaping of unfired green bodies. Acta Astronautica, 174, pp.241-253. [6] Taylor, B., Vardy, S., & MacDougall, C. (2006). Compressive strength testing of earthen plasters for straw bale wall application. In Advances in Engineering Structures, Mechanics & Construction(pp. 175-183). Springer, Dordrecht. [7] Faria, Paulina, and Vitor Silva. "Natural hydraulic lime mortars: influence of the aggregates." Historic Mortars. Springer, Cham, 2019. 185-199. [8] Mueller, R. et al. (2019). “NASA Centennial Challenge: 3D Printed Habitat, Phase 3 Final Results.” 70th International Astronautical Congress (IAC), October 21-25, 2019, Washington, DC. [9] Biggerstaff, A., Fuller, G., Lepech, M., & Loftus, D. (2021). Determining the yield stress of a Biopolymer-bound Soil Composite for extrusion-based 3D printing applications. Construction and Building Materials, 305, 124730. [10] Seitz, S. (2019). “Building Materials for the Moon & Mars: Mortar Testing Methods for Regolith.” ASCE EMI – MS99, Pasadena, CA. [11] ASTM (2021). ASTM C109 - Standard Test Method for Compressive Strength of Hydraulic Cement Mortars (Using 2-in. or (50-mm) Cube Specimens). [12] ASTM (2021). ASTM C136 - Standard Test Method for Sieve Analysis of Fine and Coarse Aggregates. West Conshohocken, Pennsylvania: ASTM International. [13] ASTM (2021). ASTM C144 - Standard Specification for Aggregate for Masonry Mortar. West Conshohocken, Pennsylvania: ASTM International. [14] Deutsches Institut Fur Normung E.V. (2018). “DIN 18947 - Earth plasters – Requirements, test and labelling.” https://dx.doi.org/10.31030/2897115. [15] EN 1015-11:1999; Methods of Test for Mortar for Masonry—Part 11: Determination of Flexural and Compressive Strength of Hardened Mortar. BSI.

Issues addressed How health promotion is implemented varies and it is often not clear what activities are in place in a region. Understanding the extent of health promotion activities helps planning activities. Methods This research involved a rapid audit of the types of health promotion activities in a suburban region of South Australia . This analysis was guided by the WHO Ottawa Charter's principles. To better understand population needs and which health promoting activities may help, an epidemiological, demographic and social determinants of health profile of southern Adelaide described disease patterns and health inequities. Results While there was evidence of a range of health promoting activities, , most concerned individual or behavioural services. A key finding was the small number of activities that the state health department and local health system were responsible for. Alongside local government, NGOs provided the bulk of health promotion activities. In addition, there were no overarching health promotion strategies or coordinating bodies to evaluate the activities. The epidemiological, demographic and social determinants of health profile found persistent health and social inequities. Conclusion This rapid audit of health promotion in a region enabled a quick assessment of the current health promotion situation and provided evidence of gaps and areas where policy change should be advocated. SO WHAT?: The key findings distilled from this research were designed to inform policy priorities to shift health promotion in southern Adelaide onto a trajectory consistent with the Ottawa Charter and prevent further focus on individualised behaviour change strategies known as 'lifestyle drift'.

Internationally, there has been a concerted policy focus on the integration of early years services to support children and families by bridging the divide between early childhood care and educatio...

This paper presents the results of a study on pre-engineered steel and aluminum, nominally “pinned”, bolted-plate (BP), staggered dovetail (S-DT), and dovetail prototype (DTP) beam-hanger connection systems for glue-laminated timber joints under a combination of shear and reversed cyclic loading. A total of seven systems were tested to observe the evolution of damage, failure modes, and moment–rotation behaviour. The interstorey drift and deflection of a building that would cause failure of each system is inferred from the ultimate rotation capacities and compared to the limit(s) prescribed by Clause 4.1.8.13.3 of the National Building Code of Canada for various building categories. The BP systems generally reached an interstorey drift exceeding 2.5%, while the S-DT and DTP systems reached drifts of 0.6% and >1.2%, respectively. The BP systems also exhibited more ductile failure modes than the S-DT and DTP systems, involving withdrawal failure of the wood screws. Recommendations are made for appropriate connectors to use in each building category considered.

Despite increased efforts within child wellbeing research to include children’s perspectives in our knowledge of child wellbeing, young children’s voices continue to be largely excluded. As the transition to school is widely understood as a key time to assess child wellbeing, preschool aged children are a frequent target of child wellbeing indicator use, making their exclusion from child wellbeing knowledge problematic. This study sought to redress preschool aged children’s exclusion from child wellbeing indicator research through investigating their perspectives of wellbeing. Using a citizen-child approach to participatory research, three-to-five-year-old children attending eight diverse early childhood education and care services in Australia shared their experiences and understandings of wellbeing. Children’s accounts were compared to adult derived child wellbeing frameworks to determine the way children’s accounts accorded and differed from current conceptualisations. The findings evidenced that young children’s accounts further validated current adult derived child wellbeing indicators. Additionally, children’s accounts uncovered two novel indicators yet to be explored in relation to child wellbeing social indicator frameworks: opportunities for play, and young children’s agency. The role of agency and play in children’s conceptualisations of wellbeing are considered in light of contemporary empirical research and will be of keen interest to those education and public health professionals and policy-makers concerned with improving child wellbeing outcomes.

Summary Preventing vancomycin-resistant enterococci (VRE) infection is a healthcare priority. However, the cost-effectiveness of VRE control interventions is unclear. The aim of this study was to synthesize evidence on economic evaluation of VRE control practices such as screening, contact precautions, patient cohorting, and others. The literature was searched from January 1985 to June 2018, and included economic evaluations of VRE control practices in hospital settings, published in English. A total of 4711 articles were screened; nine primary studies met our criteria. All studies evaluated some form of VRE screening and contact precautions, in populations ranging from single hospital wards (or select patient groups) to multiple healthcare facilities. There was significant variability in the interventions and comparisons used. Most studies (N = 7) conducted a cost-effectiveness analysis; two studies were cost-consequence studies. All economic evaluations were from the hospital perspective. Four studies found implementing enhanced VRE-specific control practices to be cost-effective/cost-saving and two studies found that discontinuing VRE-specific control practices was not cost-effective. Three studies found decreasing VRE-specific control practices to be cost-effective/cost-saving. The quality of the included studies was generally low according to the Joanna Briggs Institute (JBI) checklist for economic evaluations; major limitations included risks of bias in intervention effect estimates, and a lack of sensitivity analyses. Most studies show that some form of VRE screening and use of Contact Precautions is cost-effective. The low study quality and heterogeneity of interventions and comparators precludes definitive conclusions about the cost effectiveness of specific VRE control interventions. Additional high-quality economic evaluations are needed to strengthen the available evidence.

The university student population is the largest adolescent group in Iran. we aimed to measure the prevalence of sexual and illicit substance use risk behaviours among university students in Tehran, Iran. This study employed a quantitative method strategy to study Iranian university students. An anonymous quantitative survey was conducted using a self-administrated questionnaire. About 392/400 (98.0%) of invited students completed the survey with an average age of 21.98 (18-35), and 58.7% male. Lifetime substance use was reported by 14.8% of participants. The most commonly used substances were grass (11 .0%), hallucinogens (4.1%), and cocaine (2.6%). Moreover, 36.7% of participants reported sexual contacts within the last 12 months. Compared to females, more males reported condom use in last sexual contact (30.7% vs. 10.0%, P < 0.005), and multiple sexual partners (40.6% vs. 16.7%, P < 0.005). About, 34 (27.2%) participant reported sex with a sex worker or a person who had a multiple sexual partner. Group sex was reported by 5.1% of participants. Illicit substance use and unprotected sex are considerably high among university students. More effective prevention programs accessible to them are needed to reduce their vulnerability to associated harms to such risk behaviours.

Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government’s decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives.

An experimental investigation of the withdrawal resistance of self-tapping screws (STS) inserted parallel-to-grain in Douglas fir and eastern white pine, dry (7% – 6% MC) and wet (28% MC), is conducted. Withdrawal tests with 10 mm screws showed that at an embedment length of 240 mm in dry Douglas fir, 280 mm in wet Douglas fir, and 320 mm in dry eastern white pine, the screws consistently failed by yielding in tension. Withdrawal tests of 12 mm screws and a constant embedment length of 280 mm showed that a longer embedment length is needed compared to the 10 mm screws to ensure tensile screw failure consistently occurs. For both the 10 mm and 12 mm screws, the withdrawal resistance was lower for the wet wood as compared to dry. The CSA O86 equation for lag screws significantly under-predicts the withdrawal resistance of STSs inserted parallel-to-grain.

Straw bale construction has a proven track record as a viable alternative for residential construction. Structural (load-bearing) straw bale panels typically consist of stacked straw bales and plaster skins. These systems exploit the structural capacity of the plaster/straw composite. The plaster is critical for providing structural strength and stiffness, as well as protection against pests, moisture, and fire. However, plastering bales is labour intensive and costly. A recent development has been dry bale wall (DBW) panels. These panels have a perimeter timber frame, recycled wood sheathing on both sides and straw bale infill. By eliminating the labour-intensive plastering of traditional straw-bale walls, DBW panels can be constructed rapidly and off-site in a sheltered environment, thus preventing exposure of the straw to moisture during construction. This paper describes the gravity and transverse load testing (based on ASTM E72 -15 [3] ) of DBW panels in-filled with wheat straw bales. To evaluate their strength capacity and failure modes is described. The out-of-plane flexural (OPF) tests exhibited a mean allowable bending moment of 1.80kNm with a factor of safety of 3. The axial compression (AC) tests exhibited a mean allowable line load of 22.8 kN/m with a factor of safety of 2.5. The local flexural header beam (HP) tests exhibited an allowable line load of 11.2 kN/m with a factor of safety of 3. The OPF and AC capacities of the DBW exceeded the Abbasi (2014)’s conventional structural insulated (STUD) wall. However, the DBW’s header beam strength and stiffness was inferior to Abbasi (2014)’s STUD wall.

This mixed-methods study explored the role of connection to the natural environment in recovery from the 'Black Saturday' bushfires that blazed across Victoria, Australia, in February 2009. Qualitative findings demonstrated that many participants had a strong connection to the natural environment, experienced considerable grief as a result of its devastation in the fires and drew solace from seeing it regenerate over the following months and years. Quantitative analyses indicated that a strong attachment to the environment was associated with reduced psychological distress, fewer symptoms of major depression and fire-related PTSD, and higher levels of resilience, post-traumatic growth and life satisfaction. While social connections are increasingly recognized as supportive of disaster recovery, the influence of landscapes also needs to be recognized in terms of the impact of their destruction as well as their therapeutic potential.

Past research has demonstrated an association between financial hardships and risk-taking behaviors (defined as delinquent or transgressive acts). However, this effect may differ based upon the provision of protective spaces, like those offered in extracurricular activities. In the current study, we examined the longitudinal effect of financial hardships on risk-taking in a sample of Australian adolescents ( N = 3,852). We found experiences of financial hardship at the age of 12/13 predicted higher risk-taking 2 years later. Further, a longitudinal indirect effect was observed, where financial hardships were associated with higher risk-taking 4 years later via increased exposure to risk-taking peers. Non-sporting activity participation (e.g., debating, dance) was found to offset the risks associated with experiencing financial hardships. Participation in sports was not significantly related to any of our outcomes. Our data highlights how the provision of non-sporting activities may improve behavioral outcomes, especially among more financially disadvantaged adolescents.

This chapter presents evidence to inform evolving Coronavirus disease (COVID-19) response planning by analysing how Australians were thinking, feeling and behaving in response to the so-called “first wave” of the COVID-19 epidemic and the associated public health measures. Australia has a federated political system featuring overlapping responsibilities between a federal government, eight state and territory governments and local governments. The political geography of Australia, as an island continent, has informed the shape of the responses. The questionnaire was administered online to members of the YouGov Australia panel of individuals who have agreed to take part in surveys of public opinion. Respondents were asked to report their level of worry about the COVID-19 situation in Australia. High numbers of respondents in both Surveys provided free text responses criticising the behaviour of other people, suggesting some sort of moral, character or behavioural flaw.

Leadership in public health is necessary, relevant, and important as it enables the engagement, management, and transformation of complex public health challenges at a national level, as well as collaborating with internal stakeholders to address global public health threats. The research literature recommends exploring the journey of public health leaders and the factors influencing leadership development, especially in developing countries. Thus, we aimed to develop a grounded theory on individual leadership development in the Nepalese context. For this, we adopted constructivist grounded theory, and conducted 46 intensive interviews with 22 public health officials working under the Ministry of Health, Nepal. Data were analysed by adopting the principles of Charmaz’s constructivist grounded theory. The theory developed from this study illustrates four phases of leadership development within an individual–initiation, identification, development, and expansion. The ’initial phase’ is about an individual’s wishes to be a leader without a formal role or acknowledgement, where family environment, social environment and individual characteristics play a role in influencing the actualisation of leadership behaviours. The ’identification phase’ involves being identified as a public health official after having formal position in health-related organisations. The ’development’ phase is about developing core leadership capabilities mostly through exposure and experiences. The ’expansion’ phase describes expanding leadership capabilities and recognition mostly by continuous self-directed learning. The grounded theory provides insights into the meaning and actions of participants’ professional experiences and highlighted the role of individual characteristics, family and socio-cultural environment, and workplace settings in the development of leadership capabilities. It has implications for academia to fulfill the absence of leadership theory in public health and is significant to fulfill the need of leadership models grounded in the local context of Asian countries.

IntroductionA well-established body of literature demonstrates that health and equity are strongly influenced by the consequences of governments’ policy and resultant actions (or inactions) outside the health sector. Consequently, the United Nations, and its agency the WHO, have called for national leadership and whole-of-government action to understand and address the health impacts of policies inallsectors. This research responds to that call by investigating how policymaking in four sectors—urban planning, justice, energy and environment—may influence the social determinants of health and health equity (SDH/HE).Methods and analysisThe research design is informed by a critical qualitative approach. Three successive stages are included in the design. The first involves analysing all strategic policy documents and selected legislative documents from the four sectors (n=583). The document analysis is based on a coding framework developed to identify alignment between the documents and the SDH/HE. Two policies that demonstrate good practice in regard to SDH/HE will be selected from each sector during the second stage for embedded case study analysis (total n=8). This is intended to illuminate which factors have supported recognition and action on SDH/HE in the selected policies. The third stage involves progressive theoretical integration and development to understand political and institutional facilitators and barriers to action on SDH/HE, both within and between sectors.Ethics and disseminationThe research will provide much needed evidence about how coherent whole-of-government action on SDH/HE can be advanced and contribute knowledge about how health-enhancing policy activity in the four sectors may be optimised. Learnings from the research will be shared via a project advisory group, policy briefings, academic papers, conference presentations and research symposia. Ethics approval has been secured for the embedded case studies, which involve research participants.

Objective This case study examined implementation of the National Health Services Standards (NHSSs) as a continuous quality improvement (CQI) process at three church-based health facilities in Papua New Guinea. This process was designed to improve quality of care and accredit the level three health centers to level four as district hospitals to provide a higher level of care. The aims of the paper are to critically examine driving and restraining forces in CQI implementation and analyses how power influences agenda setting for change. Methods Semi-structured interviews were conducted with nine managers and eight health workers as well as three focus group discussions with health workers from three rural church-based health facilities in Morobe and Madang provinces. They included senior, mid-level and frontline managers and medical doctors, health extension officers, nursing officers and community health workers. Thematic analysis was used as an inductive and deductive process in which applied force field analysis, leadership-member exchange (LMX) theory and agenda setting was applied. Results Qualitative analysis showed how internal and external factors created urgency for change. The CQI process was designed as a collective process. Power relations operated at and between various levels: the facilities, which supported or undermined the change process; between management whereby the national management supported the quality improvement agenda, but the regional management exercised positional power in form of inaction. Theoretical analysis identified the ‘missing bit in the middle’ shaped by policy actors who exercise power over policy formulation and constrained financial and technical resources. Analysis revealed how to reduce restraining forces and build on driving forces to establish a new equilibrium. Conclusion Multiple theories contributed to the analysis showing how to resolve problematic power relations by building high-quality, effective communication of senior leadership with mid-level management and reactivated broad collaborative processes at the health facilities. Addressing the ‘missing bit in the middle’ by agenda setting can improve implementation of the NHSSs as a quality improvement process. The paper concludes with learning for policy makers, managers and health workers by highlighting to pay close attention to institutional power dynamics and practices.

Objectives: To profile the long-term mental health outcomes of those affected by the 2009 Black Saturday bushfires and to document the course of mental health since the disaster. Method: The longitudinal Beyond Bushfires study included 1017 respondents (Wave 1; 3–4 years after the fires), 736 (76.1%) at Wave 2 (5 years after the fires) and 525 (51.6%) at Wave 3 (10 years after the fires). The survey indexed fire-related and subsequent stressful events, probable posttraumatic stress disorder, major depressive disorder, alcohol use, severe distress and receipt of health services for mental health problems. Results: Relative to their status 3–4 years after the fires, there were reduced rates of fire-related posttraumatic stress disorder (6.2% vs 12.2%), general posttraumatic stress disorder (14.9% vs 18.7%) and severe distress (4.4% vs 7.5%) at 10 years. There were comparable rates between Wave 1 and Wave 3 for depression (10.9% vs 8.3%) and alcohol abuse (21.8% vs 18.5%). Of people in high-affected regions, 22.1% had posttraumatic stress disorder, depression or severe distress at Wave 3. One-third to one-half of participants who reported probable posttraumatic stress disorder or depression at any assessment did not display the disorder at the next assessment. Worsening of mental health at Wave 3 was associated with the extent of property loss, exposure to recent traumatic events or recent stressful life events. Only 24.6% of those with a probable disorder had sought professional help for this in the previous 6 months. Conclusion: Approximately one-fifth of people from high-affected areas have a probable psychological disorder a decade after the fires. Mental health appears to fluctuate for those who are not consistently resilient, apparently as a result of ongoing stressors. The observation that most people with probable disorder are not receiving care highlights the need for further planning about managing long-term mental health needs of disaster-affected communities.

Background This paper reports on a five-year study using a theory-based program logic evaluation, and supporting survey and interview data to examine the extent to which the activites of the South Australian Health in All Policies initiative can be linked to population health outcomes. Methods Mixed-methods data were collected between 2012 and 2016 in South Australia (144 semi-structured key informant interviews; two electronic surveys of public servants in 2013 (n = 435) and 2015 (n = 483); analysis of state government policy documents; and construction of a program logic model to shape assessment of the feasibility of attribution to population health outcomes). Results Multiple actions on social determinants of health in a range of state government sectors were reported and most could be linked through a program logic model to making some contribution to future population health outcomes. Context strongly influences implementation; not all initiatives will be successful and experimentation is vital. Successful initiatives included HiAP influencing the urban planning department to be more concerned with the health impacts of planning decisions, and encouraging the environment department to be concerned with the health impacts of its work. Conclusions The theory-based program logic suggests that SA HiAP facilitated improved population health through working with multiple government departments. Public servants came to appreciate how their sectors impact on health. Program logic is a mechanism to evaluate complex public health interventions in a way that takes account of political and economic contexts. SA HiAP was mainly successful in avoiding lifestyle drift in strategy. The initiative encouraged a range of state government departments to tackle conditions of daily living. The broader underpinning factors dictating the distribution of power, money and resources were not addressed by HiAP. This reflects HiAP’s use of a consensus model which was driven by (rather than drove) state priorities and sought ‘win-win’ strategies.

Anger is an important dimension of affect and a prominent feature of posttraumatic mental health, but it is commonly overlooked in postdisaster settings. We aimed to examine the distribution and implications of significant anger problems in the aftermath of a natural disaster, via analyses of Beyond Bushfires survey data from 736 residents of rural communities 5 years after the 2009 Black Saturday bushfires in Victoria, Australia. Assessments included the five-item Dimensions of Anger Reaction (DAR-5) scale along with measures of PTSD, depression, and significant mental illness, and indicators of life satisfaction, suicidality, hostile aggressive behavior, and violence exposure. The results indicated that approximately 10% of respondents from areas highly affected by the bushfires scored above the provisional cutoff criteria for significant anger problems on the DAR-5, which was a more than 3-fold increase, OR = 3.26, relative to respondents from areas of low-to-moderate bushfire impact. The rates were higher among women, younger participants, and those who were unemployed, and co-occurred commonly, although not exclusively, with other postdisaster mental health problems. Anger problems were also associated with lower life satisfaction, β = -.31, an 8-fold increase in suicidal ideation, OR = 8.68, and a nearly 13-fold increase in hostile aggressive behavior, OR = 12.98. There were associations with anger problems and violence exposure, which were reduced when controlling for covariates, including probable PTSD. The findings provide evidence indicating that anger is a significant issue for postdisaster mental health and should be considered routinely alongside other posttraumatic mental health issues.

This paper reflects on experiences of Australian public health researchers and members of research policy advisory groups (PAGs) in working with PAGs. It considers their benefits and challenges for building researcher and policy actor collaboration and ensuring policy relevance of research. Four research projects conducted between 2015 and 2020 were selected for analysis. 68 PAG members from Australian federal, state and local governments, NGOs and academics participated in providing feedback. Thematic analysis of participant feedback and researchers’ critical reflections on the effectiveness and capacity of PAGs to support research translation was undertaken. PAGs benefit the research process and can facilitate knowledge translation. PAG membership changes, differing researcher and policy actor agendas, and researchers’ need to balance policy relevance and research independence are challenges when working with PAGs. Strategies to improve the function of health policy research PAGs are identified. The paper suggests a broader adapted approach for gaining the benefits and addressing the challenges of working with PAGs. It opens theoretical and practical discussion of PAGs’ role and how they can increase research translation into policy.

The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.

Previous studies of the impact of post-trauma research participation indicate that while the research experience may be emotional, it can still be valued by participants. This paper describes participant experiences of the Australian post-bushfire research study–Beyond Bushfires. It examines the relationships between distress during research participation, probable mental health conditions, and satisfaction with the research experience over time. A range of strategies was incorporated into the study, including a distress and risk assessment and referral protocol, to minimise any risk of harm for people who had experienced the 2009 bushfires and their aftermath. Participants included 1056 respondents (Wave 1) interviewed via telephone and web-based survey between December 2011 through January 2013, and 736 (76.1%) of the participants were re-surveyed between July and November 2014 (Wave 2). Research impact was monitored through two questions about survey experience on each occasion. Reported distress at completing the survey was generally low, while overall satisfaction was relatively high. Participants’ reported satisfaction was not associated with their reported level of distress as a result of the survey; and reported participation distress at Wave 1 did not predict whether a respondent would return to complete the survey at Wave 2. Fire-related Posttraumatic stress symptoms were associated with increased satisfaction and likelihood to return at Wave 2. These findings suggest that for Beyond Bushfires survey respondents the perceived benefits outweighed the costs of participation over time.

Parents of children with Autism Spectrum Disorder are responsible for deciding which interventions to implement with their child. There is limited research examining parental decision-making with regards to intervention approaches. A constructivist grounded theory methodology was implemented in this study. Semi-structured interviews were undertaken with 14 participants from 12 family units. Data collection and analysis occurred concurrently, allowing a grounded theory to be constructed. Parental decision-making was influenced by many factors, arranged into seven core categories (values, experience, information, motivation, understanding, needs and logistics). Decision-making evolved over time, as parents transformed from 'parent' to 'expert'. The results of this study provide an insight into parental decision-making, which has implications for the support provided to parents by health professionals.

This paper describes the hot-box testing (based on ASTM C1363-11) of seven straw bale wall panels to obtain their thermal conductivity values. All panels were constructed with stacked bales and cement-lime plaster skins on each side of the bales. Four panels were made with traditional, 2-string field bales of densities ranging from 89.5 kg/m3–131 kg/m3 and with the bales on-edge (fibres perpendicular to the heat flow). Three panels were made with manufactured high-density bales (291 kg/m3–372 kg/m3). The fibres of the manufactured bales were randomly oriented. The key conclusion of this paper is that within the experimental error, there is no difference in the thermal conductivity value for panels using normal density bales and manufactured high density bales up to a density of 333 kg/m3. However, because of lack of precision of the hot-box, no conclusions can be made on the true thermal conductivity of the high density bale panels. In addition, the panels tested were found to have significant voids between bales, and this is believed to have contributed to higher measured thermal conductivity values compared to those reported in the literature for normal density bale panels. Thermal properties may be affected for bales with higher densities than 333 kg/m3, therefore further testing is suggested.

Background The importance of evaluating policy processes to achieve health equity is well recognised but such evaluation encounters methodological, theoretical and political challenges. This paper describes how a program theorybased evaluation framework can be developed and tested, using the example of an evaluation of the South Australian Health in All Policies (HiAP) initiative. Methods A framework of the theorised components and relationships of the HiAP initiative was produced to guide evaluation. The framework was the product of a collaborative, iterative process underpinned by a policy-research partnership and drew on social and political science theory and relevant policy literature. Results The process engaged key stakeholders to capture both HiAP specific and broader bureaucratic knowledge and was informed by a number of social and political science theories. The framework provides a basis for exploring the interactions between framework components and how they shape policy-making and public policy. It also enables an assessment of HiAP’s success in integrating health and equity considerations in policies, thereby laying a foundation for predicting the impacts of resulting policies. Conclusion The use of a program theory-based evaluation framework developed through a consultative process and informed by social and political science theory has accommodated the complexity of public policy-making. The framework allows for examination of HiAP processes and impacts, and for the tracking of contribution towards distal outcomes through the explicit articulation of the underpinning program theory.

Background This paper examines the extent to which actors from sectors other than health engaged with the South Australian Health in All Policies (HiAP) initiative, determines why they were prepared to do so and explains the mechanisms by which successful engagement happened. This examination applies theories of policy development and implementation. Methods The paper draws on a five year study of the implementation of HiAP comprising document analysis, a log of key events, detailed interviews with 64 policy actors and two surveys of public servants. Results The findings are analysed within an institutional policy analysis framework and examine the extent to which ideas, institutional factors and actor agency influenced the willingness of actors from other sectors to work with Health sector staff under the HiAP initiative. In terms of ideas, there was wide acceptance of the role of social determinants in shaping health and the importance of action to promote health in all government agencies. The institutional environment was initially supportive, but support waned over the course of the study when the economy in South Australia became less buoyant and a health minister less supportive of health promotion took office. The existence of a HiAP Unit was very helpful for gaining support from other sectors. A new Public Health Act offered some promise of institutionalising the HiAP approach and ideas. The analysis concludes that a key factor was the operation of a supportive network of public servants who promoted HiAP, including some who were senior and influential. Conclusions The South Australian case study demonstrates that despite institutional constraints and shifting political support within the health sector, HiAP gained traction in other sectors. The key factors that encouraged the commitment of others sectors to HiAP were the existence of a supportive, knowledgeable policy network, political support, institutionalisation of the ideas and approach, and balancing of the economic and social goals of government.

Background Intersectoral action on social determinants of health to reduce health inequities requires policy research beyond the usual social and human services. We ask how Australian energy policy affects health equity. Methods Document analysis and policy case studies on how goals, objectives and strategies of all Australian energy policies address equity. Results Energy policy affects health via risk from unreliable energy; difficult transitions to renewables; disproportionate effects on poorer people faced with high energy bills versus other basics; ecological degradation; cost pressures on businesses and governments; job losses and policy paralysis about renewable energy and climate change. Policy features subsidies for the disadvantaged; privatisation and artificial markets; differing geographical distribution of resources and high level political conflict about whether it can deliver on 3, or only 2, of the ’energy trilemma’ of reliability, affordability and ecological sustainability. Mining, industrial and political interests, powerful enough to orchestrate the downfall of Australian prime ministers, actively close policy links between health, climate change and energy. Bridging energy and health policy requires political support for market solutions involving renewables; community generation of renewable energy; solutions for rural and remote areas; and global treaties. Intergenerational equity is a strong policy lever. Conclusions Health in All Policies approaches can creatively engage with the language and concepts of energy policy via the daily conditions of living, inequity and climate change. When it is difficult to engage, researchers can connect with non-government organisations who bridge sectors through simultaneous advocacy for equitable health, climate and energy policies. Key messages Powerful interests burn bridges between health equity and energy policy. Local and global policy levers harmonising terminology differences build bridges between energy, climate change and health equity.

Background In February 2009 Victorian rural communities were hit by the worst bushfires in Australian history. Immediately we evaluated community groups preparing residents for bushfires. Ten years on, we are one of the few teams to evaluate medium to long term community recovery using multiple methods. As climate change becomes more visible, the frequency and intensity of disasters will increase so communities, governments and service providers need more evidence based strategies and policies. We explore how participant led visual methods provide new knowledge. Methods In study 1 participants in 3 of 7 focus groups in peoples’ homes spontaneously brought photos for us to examine before the discussions. In another participants spoke of the importance of photos they took at the time. We returned to the field to interview people in their homes about the meaning and role of photos. Results Participants wanted to inform us-as outsiders-of the awe and enormity of the fires. They created a visual record to communicate with key interest groups and ward off complacity as memories receded. Photos helped them construct timelines and meanings of the intense fires. Crucially, they recorded recovery and rebuilding in both the built and natural environments. Over the next ten years we chronicled stories from community led visual methods of communication, recovery and empowerment. We incorporated into qualitative methods participant led tours of their environments, with visual methods. Visual data collected by communities focused more strongly on the natural environment than researcher led verbal methods. Conclusions Visual sociology changes as technology provides participants in research with increased access to, and control over, visual methods. These changes can rebalance power relations between qualitative researchers and participants and bridge visual and verbal methods; crafting striking stories to influence those Australian policies unresponsive to climate change. Key messages Technological change enables participants in qualitative research to initiate visual methods to build bridges between them and researchers. Community led visual methods provide new types of data useful for theory and knowledge translation.

The Health in All Policies (HiAP) approach aims to create coherent policy across government that will improve population health, wellbeing and equity while progressing the goals of other sectors. The quest to achieve policy coherence across government has focused interest on processes that facilitate collaboration between health and many other sectors. Health and education sectors have long been seen as natural partners with mutually beneficial goals. This article focuses on a case study of HiAP work, undertaken between health and education in South Australia to increase parental engagement in children’s literacy among lower socio-economic families. It draws on a document analysis of 71 documents, seven in-depth interviews with senior policy actors and a programme logic model. The project began with the intention of using policy levers to improve long-term health outcomes through addressing child literacy, a proven social determinant of health. Because of the context in which it was operating, the project extended from a focus on policy to working directly with four schools implementing strategies to facilitate parental engagement, with the intention of finally influencing system-wide education policy. We use an institutional framework to support our analysis through a discussion of ideas, actors and institutions and how these influenced the project. The article provides insight into the facilitators and impediments to intersectoral efforts to progress shared educational and health goals and achieve sustainable change, and identifies lessons for others intending to use this approach.