Co-Designing the Health4Me Text Message Intervention to Support and Improve Adolescent's Physical and Mental Health Outcomes: An Active Research Partnership With Adolescents

Background: Despite suboptimal lifestyle health behaviours, current approaches to adolescent cardiovascular disease (CVD) prevention are proving ineffective. Researchers have the responsibility to engage with adolescents as research partners. The aim is to co-design the Health4Me text message nutrition and physical activity support program with an adolescent advisory panel. Methods: Iterative, mixed methods process with consumer partnership. We assembled a consumer group of 16 youth advisors (13-18-years), named Health Advisory Panel for Youth at The University of Sydney (HAPYUS). HAPYUS is an evidenced-based leadership and collaboration initiative. The first co-design step to develop the text message content included identifying the top issues related to CVD prevention grounded in their lived experience via online workshops and an online conversation thread. Results: The top issues raised by HAPYUS related to CVD prevention were unbalanced nutritional intake, physical inactivity and mental health concerns, which are interconnected through the inimical rise of social media. HAPYUS also identified how issues have been exacerbated by the COVID-19 pandemic and will continue to be amplified with ongoing global issues (e.g., climate change). Conclusion: Engagement with HAPYUS has identified key issues and barriers relating to CVD prevention among adolescents. This work will enable development of content for an automated text message intervention suitable for testing in the Health4Me randomised controlled trial. This RCT will determine the effectiveness of the 6-month healthy lifestyle text message intervention to improve physical and mental health outcomes in adolescents compared to usual care.

Scope of Quality Improvement-Practice Incentive Program (QI-PIP): How Primary Care Practices Can Utilise QI-PIPs by Participating in a Quality Improvement Program (QUEL Study) Focussed on Improving Cardiovascular Disease

Background: To encourage primary care practices to undertake continuous quality improvement, the Australian Government fund a Quality Improvement Practice Incentive Program (QI-PIP). In the context of cardiovascular disease (CVD), practices can use their data to provide high-quality patient care. The study aimed to evaluate the use of QI-PIP in primary care to improve management of CVD. Methods: In a sub-study of the QUality improvement for Effectiveness of care for people Living with heart disease (QUEL) cluster randomised controlled trial, 27 Australian primary care practices participated in a 12-month data-driven quality improvement (QI) program. In the end, practice team members were invited to complete a survey on their experience of claiming QI-PIP. Eligible practices could claim up to $12,500 per quarter as part of QI-PIP. Descriptive statistical analysis was used to analyse the responses and qualitative analysis explored barriers and enablers to using QI-PIP. Results: 20 practices completed the survey;total 38 QI-PIPs were claimed by 55% practices during the 12 months. The Average number of QI-PIP claimed was 3.45 (SD±1.57). 45% practices agreed that the availability of QI-PIP facilitated their participation in QI activities. Qualitative analysis identified several enablers including, QI-PIP motivated the practices to support research, proactively monitor chronic disease management, helped to identify and meet KPIs. Barriers were time constraints and COVID-19 Pandemic. Conclusion: Approximately, one-third of practices participating in QUEL claimed the QI-PIP. More research is needed to assist the practices to best utilise the incentive program and overcome the barriers to its implementation in managing CVD.

FirstCPR Process Evaluation: Recruitment and Engagement in a Community-Based Intervention Aimed at Training and Willingness to Respond to Cardiac Arrest in the Community

Background: An important stage of process evaluation in community-based interventions is assessing recruitment and engagement. Such an evaluation is being conducted alongside the FirstCPR cluster-randomised trial, which aims to increase community-level training and willingness to respond to cardiac arrests by providing education and training to members of community-based organisation. FirstCPR’s process evaluation sought to: (1) examine recruitment and understand barriers and enablers to organisation participation;and (2) examine the intervention’s fidelity and reach, including contextual factors related to participant engagement. Methods: A mixed-methods evaluation, integrated data collected during organisation recruitment comprising both quantitative record-keeping and qualitative coding. Quantitative data included recruitment rates, reasons for refusal, and organisational features;qualitative codes emerged from study-team observations. Descriptive analyses were used for quantitative data and thematic analyses for qualitative data. Results: In total, 220 (constituting 55% social/faith groups, 39% sports organisations, 6% workplaces/businesses) of 385 eligible organisations declined to participate. Lack of sufficient time to facilitate the project at their organisations, difficulties prioritising the program given competing activities, and COVID-related restrictions emerged as principal reasons for declining. Thematic analyses suggested that an organisation’s perception of the value of FirstCPR’s training was a key factor motivating enrolment. Conclusions: Organisational barriers included COVID restrictions, lack of perceived relevance, and staffing limitations. Obtaining adequate enrolment is essential for the generalisability of community intervention trials such as FirstCPR. Further semi-structured interviews with organisation leaders will delve into contextual factors that facilitated or impeded the intervention’s planned delivery;study records and web-analytics will inform intervention’s fidelity and reach.

HEALTH SUPPORT FOR AUSTRALIAN BREAST CANCER SURVIVORS VIA TEXT MESSAGES DURING COVID19 LOCKDOWNS: RESULTS OF A NATIONAL PRE-POST STUDY

Introduction COVID19 cancelled in-person breast cancer support in Australia. Text messages are effective at providing health support. Aim: Evaluate cost, uptake, reach and utility of a 3-month co-designed (consumers/clinicians/ researchers) lifestyle-focused text message program 'EMPOWER-SMS'. Methods Participants were recruited (Apr'20-Feb'21) via breast cancer organisations' social media and emails. Inclusion: Adults, finished active breast cancer treatment (surgery/chemotherapy/radiotherapy), lived in Australia, owned a mobile phone, sufficient English for e-consent. Exclusion: metastatic breast cancer. Online survey at baseline: Demographics and postcode (coded to Index of Relative Socio-economic Advantage and Disadvantage [IRSAD];1 least to 5 most advantaged). At 3-months: program feedback for ease-of-understanding, utility, perceived health management (5-Point Likert Scale;strongly [dis]agree), open-text feedback (coded thematically). Results Ads cost $2641. Participants' (N=845) mean age: 59±10yrs (range 30-87yrs), 48% resided in less advantaged areas (IRSAD 1-3). Survey participants (n=452) agreed/strongly agreed EMPOWERSMS was easy-to-understand (99%), useful (83%), helpful for managing health (69%), exercise (70%), healthy diet (70%). Key themes: 'feeling supported/less lonely', 'friendly reminders', 'sad it ended', 'some messages too simple'. Conclusions With low cost ($3.1/enrolment), 845 diverse participants enrolled and found it useful, overcoming support barriers during COVID19.

Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.