A hospital-based asynchronous ENT telehealth service for children with otitis media: Cost-minimisation and improved access.

AIM: The purpose of this study is to explore the effectiveness of a hospital-based asynchronous ear, nose, and throat (ENT) telehealth service (the Ear Portal) in reducing cost and improving access for children with otitis media. METHODS: Participants were recruited to the Ear Portal from a tertiary hospital ENT waiting list. Ear and hearing assessments were conducted during appointments by the Ear Portal research assistant, and data was stored for an asynchronous review by the Ear Portal multidisciplinary team. A cost-minimisation analysis was conducted for the Ear Portal and the standard care pathways. Waiting times to provide care for both pathways were calculated for children with semi-urgent (i.e. Category 2) and non-urgent (i.e. Category 3) referrals. RESULTS: The running cost for the Ear Portal was $67.70 for initial appointments and $37.34 for follow-up appointments. Conversely, the running cost for the standard care pathway was $154.65 for initial appointments and $86.10 for follow-up appointments. A total of 223 appointments were required to offset the initial Ear Portal investment of $19,384.00. The median waiting time for the Ear Portal from initial contact to care plan delivery was <30 days, whereas the median waiting times for children in the standard care pathway were 291 days (interquartile range (IQR) = 117) for Category 2 and 371 days (IQR = 311) for Category 3 referrals. CONCLUSION: Under the current circumstances, the Ear Portal service can reduce costs for the health care system by reducing marginal costs per patient in addition to providing ENT specialist care within the clinically recommended timeframes.

Local government venues' sponsorship and signage policies to limit the promotion of harmful products: A Western Australian public health audit.

OBJECTIVE: Identify and assess publicly available local government sponsorship and signage policies related to harmful products in Western Australia (WA). METHODS: An audit of WA Local Government Authority (LGAs) websites (n=139) was conducted. Sponsorship, signage, venue hire and community grants' policies were located and assessed against set criterion. Policies were scored for the inclusion of statements regarding the display and promotion of harmful commodities (alcohol, tobacco, gambling products, unhealthy food and beverages). RESULTS: Across WA local governments, 477 relevant policies were identified. Six percent (n=28) included statements restricting the promotion of at least one harmful commodity via sponsorships, signage, venue hire, and sporting and/or community grants policy. Twenty-three local governments had at least one policy that restricted unhealthy signage or sponsorship. CONCLUSIONS: Most WA local governments do not have publicly available policies that specifically limit the advertising and promotion of harmful commodities in their government-owned facilities. IMPLICATIONS FOR PUBLIC HEALTH: There is a dearth of research identifying LGA interventions addressing advertising of harmful commodities within council-owned sporting venues. This research indicates opportunities for West Australian LGAs to develop and implement policy to protect public health by restricting the promotion of harmful commodities to their communities, improving the healthfulness of environments.

Local governments' decade of organisational change to promote child health and wellbeing: a Western Australian qualitative study.

OBJECTIVE: We aim to reflect on the introduction of risk-based approaches to public health, driven by legislation outlining the expected local government public health functions and roles by identifying factors that most influenced organisational change within the Western Australia local government sector when developing and submitting child and young people's health and social policy to an annual Awards program. METHODS: This paper uses 10 years of data from a WA-based Local Government Policy Awards scheme to identify planned organisational change within the local government sector by applying a tangible organisational change model to develop a change narrative to describe factors that influenced local governments to address public health. Semi-structured interviews of 83 local government officers over the 10 years since implementation were used to create the narrative and identify factors that strengthened or hindered policy development and implementation at the local organisational level. RESULTS: Participant interviews highlighted that the Policy Award Scheme contributed to steps outlined in the Pettigrew et al. (1992) stepped model of organisational change theory to support policy development. Implications for public health: Few studies have explored these elements in their own right. We argue that advocacy for structured policy development is continually needed to support and promote internal policy prioritisation and implementation in practice.

South West Food Community: how government and community initiatives are supporting systemic change towards enhanced food security.

OBJECTIVE: Food security refers to adequate physical, social and economic access to food and is regarded as a complex, 'wicked' issue. This research aimed to understand the perspectives of initiative leaders (stakeholders), regarding their project relating to food security and its possession of characteristics associated with system change to enhance food security. METHODS: Stakeholders (n=51) participated in semi-structured interviews that evaluated initiatives (n=52) against 36 desirable characteristics for system change. Transcripts were analysed using QSR NVivo and Wicked Lab's Tool for Systemic Change. RESULTS: Community-based initiatives often harnessed the passion of local communities to enhance food security through awareness-raising activities and partnerships. Few initiatives created conflict to disrupt the current way of working. The largest 'window of opportunity' included better connection between government and community groups. CONCLUSIONS: This novel contribution provided in-depth understanding of individual initiatives and patterns of working among the food security system in the South West region of Western Australia. Implications for public health: Recommendations to better foster connection between the government and community initiatives include: ensuring government worker responsibilities include task and indicator-related measures; and strengthening understanding of food security among community groups of staff and elected member roles within local government and the ways local government could be supported to harness community knowledge.

South West Food Community: A Place-Based Pilot Study to Understand the Food Security System.

The objectives of this study were to: (i) Identify initiatives supporting healthy food availability, access and utilisation in the South West region of Western Australia (WA); and (ii) understand how they were functioning as a system to enhance community-level food security (FS). This study used a novel approach; a Systemic Innovation Lab, to interview initiative leaders/stakeholders about their FS initiative. Initiative characteristics measured included those which were associated with creating the effective conditions for FS systems change. Information was uploaded to an innovative online tool, creating a 'transition card' (matrix) of initiatives and partnering organisations. Fifty-one participants reported on 52 initiatives. Initiatives were most likely to possess characteristics relating to reinforcing changes towards an enhanced way of working to address FS and creating disruption to the old way of working. The initiative characteristic that initiatives were least likely to possess related to identifying the different causal factors of FS, and working with other stakeholders on specific components of FS. The South West Food Community pilot project used a comprehensive yet defined approach to demonstrate the value of a place-based, co-design project. Participants and stakeholders could strengthen specific initiative characteristics to facilitate enhanced community-level FS.

The volume and type of unhealthy bus shelter advertising around schools in Perth, Western Australia: Results from an explorative study.

ISSUE ADDRESSED: Exposure to advertising for unhealthy food, alcohol and gambling has been shown to influence children and adolescents' behaviours and attitudes. This exploratory study aimed to assess the volume and type of unhealthy bus shelter advertisements near schools in five local government areas in Perth, Western Australia and to monitor whether the volume of unhealthy advertisements varied seasonally. METHODS: The 29 local governments in the Perth metropolitan region were contacted seeking information regarding the locations of bus shelters featuring advertisements in their local government area. Five local governments provided sufficient information for an audit of the bus shelter advertisements in their area to be conducted. Every bus shelter within 500 m of a school was photographed and the type of advertisement recorded. The advertisements in the food, non-alcoholic beverage, alcohol, or gambling categories were then classified as being healthy, moderate, or unhealthy. This process was carried out in June, September, December 2016, and March 2017 to ascertain whether the type of advertisements displayed changed depending on the season. RESULTS: Of the 293 advertisements recorded over the four audits, 31% featured unhealthy products, 3% moderate, and <1% healthy. Only two of the 293 advertisements were classified as being healthy. Seasonal variation in the volume of unhealthy advertisements was not identified. SO WHAT?: Western Australian school students are regularly exposed to unhealthy bus shelter advertisements. Stricter regulation of outdoor advertising is needed to ensure that young people are protected from the influence of unhealthy industries.

The illusion of choice: an exploratory study looking at the top 10 food companies in Australia and their brand connections.

OBJECTIVE: To identify the brands owned by each of the 10 top grossing food companies operating in Australia and visually represent them on an infographic. METHODS: Desktop research was conducted to determine Australia's 10 largest food companies based on revenue. Brand ownership for each of the companies was traced through financial records and company publications. This information was then visually documented in the form of an infographic 'food web' to clearly illustrate company and brand ownership. RESULTS: Fonterra, Coca-Cola Amatil, Lion, Murray Goulburn, George Weston Foods, Wilmar, Nestle, Mondelez, Parmalat and Asahi were determined as the top 10 food companies operating in Australia. The food web illustrated that brand ownership ranged from 75 (Nestle) to four (Fonterra) brands per company. CONCLUSIONS: The food web illustrates the dominance of each of these major companies within Australia and shows how their diverse brand ownership limits consumer choice. Implications for public health: This study expands on current knowledge and further defines the breadth of market influence that the top 10 food companies have within the Australian food context, and how they use their brand power to create an illusion of choice for consumers. The food web will assist in promoting transparency of brand ownership in the Australian food market, therefore allowing consumers to make an informed decision about the food they purchase, and will allow community and other organisations to make an informed decision about which companies they form partnerships with.

Unhealthy sponsorship in sport: a case study of the AFL.

OBJECTIVE: To analyse the presence of unhealthy sponsorship on Australian Football League (AFL) club websites and player uniforms. METHODS: An audit of AFL club websites and playing uniforms identified sponsors and used a traffic light system to categorise sponsors. Food and beverage sponsors were classified as Red, Amber or Green using nutrient criteria. Alcohol sponsors were classified as Red. Gambling sponsors were classified as Red (wagering companies and casinos) or Amber (venues that provide gambling and other services). Sponsors promoting healthy lifestyle concepts were classified as Green. All other sponsors were classified as Other. RESULTS: Unhealthy sponsorship on AFL club websites and player uniforms is extensive. All 18 clubs had at least one Red sponsor. Fifteen clubs were sponsored by alcohol companies. Five clubs featured Red sponsor logos on their playing uniforms. Twelve clubs had Green sponsors. No clubs displayed Green sponsors on their playing uniforms. CONCLUSIONS: This study identified that unhealthy sponsorship is prevalent on AFL club websites and playing uniforms. Implications for public health: Sponsorship offers companies an avenue to expose children and young people to their brand, encouraging a connection with that brand. The AFL could reinforce healthy lifestyle choices by shifting the focus away from the visual presence of unhealthy sponsorship, while taking steps to ensure that clubs remain commercially viable. Policy makers are encouraged to consider innovative health promotion strategies and work with sporting clubs and codes to ensure healthy messages are prominent.