Mental Health Status, Risk and Protective Factors for Healthcare Staff Prior to the First Major COVID-19 Outbreak in Western Australia.

Objectives: Western Australia's unique public health response delayed the first wave of community COVID-19 transmission for 2 years. We aimed to determine the status of post-traumatic stress (PTSS), depressive, and anxiety symptoms among healthcare staff in major tertiary hospitals, together with associated risk and protective factors prior to the first substantial outbreak of COVID-19. Methods: A cross-sectional study was conducted with 431 healthcare staff immediately prior to the Western Australian border re-opening in 2022. Staff were recruited via notices in email newsletters, at four tertiary hospitals and a public mental health clinic in metropolitan Perth. Validated and original questionnaires were administered via Qualtrics. Results: Moderate levels of PTSS (22.3%), depression (21.9%), and anxiety (25.9%) were reported. Pathway analyses indicated that sleep difficulties, workplace stressors, and infectious disease training were associated with higher PTSS, depression and anxiety symptoms, and younger age was associated with higher levels of depression and anxiety. Nursing roles were associated with higher PTSS. Social support and workplace support were associated with lower levels of depression and anxiety but were not associated with PTSS. Conclusion: The findings illustrate high levels of resilience, but indicate a need for structural supports within the health system to foster staff mental health prior to the onset of emergencies.

Active Ingredients of Interventions Improving Smoking Cessation Support by Dutch Primary Care Providers: A Systematic Review.

The objective was to assess active ingredients, change mechanisms, and fidelity in interventions aiming to increase the quality of smoking cessation care in the Dutch primary healthcare setting. We conducted a systematic review searching five scientific databases on August 2nd, 2019, updated on October 28th, 2021. We included effect data of behavioural interventions aiming at improving the provision of smoking cessation support by Dutch primary care providers to their patients. We excluded studies published before 2000 and those without a behavioural support intervention for primary care providers targeting smoking cessation in their patients. We found 1939 articles and included 15 distinct interventions in the review. We provided an overview of study characteristics, intervention effects, fidelity, active ingredients and change mechanisms using the Behaviour Change Techniques (BCT) Taxonomy and Mechanisms of Action (MoAs) protocols. Interventions seemed more effective when including a face-to-face component, using active learning strategies and providing a tool to help follow the guidelines in practice (e.g., physical cards with information). BCTs, MoAs, and fidelity were overall poorly reported on. To support the application of smoking cessation practices in Dutch primary care, we recommend implementation of face-to-face training programs incorporating active skill training elements combined with practical tools.

A comparison of parent-reported and self-reported psychosocial function scores of the PedsQL for children with non-severe burn.

BACKGROUND: Quality of life of paediatric patients after burn injury is often assessed through parents who may score differently to their child. Non-severe burns are the most common type of burn injury in Western Australia, however, despite low severity and high survival rates, they can cause long term physical and psychosocial problems which need to be detected early in order to provide patients with optimal holistic care. METHODS: Demographic and clinical data were collected from paediatric patients (5-16-year-old) with non-severe burns (<20% total body surface area), and Paediatric quality of life (PedsQL) questionnaires were collected from both the patient and their parent. Two cohorts of patients were assessed: first, those at approximately six months after burn, and second, those more than one-year after burn. Differences between parent-scores and self-scores were analysed using multivariate linear regression to assess the relationship between risk factors and observed differences in PedsQL scores. RESULTS: Parents reported poorer Psychosocial Function (PSF) for younger children (p = 0.01) and for patients from higher socioeconomic status areas (p = 0.05) compared to their children. In the 'Early Recovery Cohort', female patients had significantly different scores to their parents (p < 0.01). In the 'Late Recovery Cohort', parents rated older patients lower than they rated themselves (p = 0.03). CONCLUSION: Age at burn, socioeconomic status, and female gender may increase the discrepancy in quality-of-life assessments between parents and patients.

How to improve the diet of toddlers? The feasibility of an online, habit-based intervention targeting parental feeding behaviour.

Background: The diet of toddlers is often not in accordance with dietary recommendations, putting them at risk of poor health outcomes later in life. Parents can struggle to provide their toddler with a healthy diet and interventions are needed. Helping parents to form healthy feeding habits may facilitate healthy feeding behaviours. Therefore, the aim of this study was to establish the feasibility of a 6-week online intervention to build healthy feeding behaviours in parents of toddlers. Methods: Parents and primary caregivers of children aged 2-3 (N = 75) were recruited to complete a 6-week online intervention consisting of 6 modules targeting habit formation, planning, goal setting, self-efficacy, interpersonal influences and picky eating. Demographics and feeding behaviours were measured with self-report at baseline and follow-up. Intervention acceptability and feasibility ratings were also gathered post-intervention. Results: Most participants were recruited online, highly educated and in a relationship. After 6-weeks, 17 participants completed the follow-up questionnaire, 11 of whom indicated that they had completed the whole intervention. Improvements were found for some feeding behaviours. Generally, participants who completed the programme reported that they found it acceptable. Conclusions: This study provides insights for future intervention development. Firstly, an online healthy feeding intervention seems to be acceptable but may need to focus on fewer change techniques. Further, engagement should be improved by including target group members and compulsory reminders. The target behaviours seem to be relevant. Online recruitment seems to be preferable and reaches parents and primary caregivers nationwide.

Long term mental health trajectories after disasters and pandemics: A multilingual systematic review of prevalence, risk and protective factors.

The patterns of long-term psychological response after disasters and pandemics remain unclear. We aimed to determine the trajectories for post-traumatic stress symptoms (PTSS), depression and anxiety prevalence following disasters and pandemic exposure; and identify associated risk and protective factors. A systematic review of the English, Chinese, and Japanese longitudinal mental health literature was conducted. We searched Cochrane, MEDLINE, ProQuest, PsycINFO, PubMed, Web of Science, and CINAHL (English), CNKI and SINOMED (Chinese) and CiNii (Japanese) for studies published between January 2000 and May 2022. Following a pre-specified protocol (PROSPERO: CRD42020206424), conditional linear growth curve models and ANOVA analyses were conducted. The search identified 77,891 papers, with a final sample of 234: 206 English, 24 Chinese, and 4 Japanese-language papers. PTSS rates improved for all ages (p = .018, eta2 = 0.035). In contrast, depression and anxiety prevalence remained elevated for years following exposure (p = .424, eta2 = 0.019 and p = .051, eta2 = 0.064, respectively), with significantly higher rates for children and adolescents (p < .005, eta2 > 0.056). Earthquakes and pandemics were associated with higher prevalence of PTSS (p < .019, eta2 > 0.019). Multi-level risk and protective factors were identified. The chronicity of mental health outcomes highlights a critical need for tailored, sustainable mental health services, particularly for children and adolescents, in disaster- and pandemic-affected settings.

Providing evidence from practice: Evaluating 4.5 years of implementing diabetes education support program in carbohydrate management.

OBJECTIVE: To evaluate personal and economical outcomes of CarbSmart, a 3-hour person-centered, theory-based program implemented throughout Australia, targeting optimal dietary carbohydrate management. METHODS: More than 500 CarbSmart programs were implemented over 4.5 years. Pre-, post-, (N = 4656) and 3-month follow-up assessments (N = 188) of knowledge, empowerment, confidence, and patient activation were collected from people with diabetes. Participant satisfaction and potential annual cost-savings were calculated. FINDINGS: Repeated measures ANCOVAs showed large improvements pre- to post-program in all outcome variables (d = 0.80-1.68), which were maintained at 3-month follow-up in a sub-sample. Participant satisfaction was high (Net Promoter Score = 72.3). Potential annual cost-savings nation-wide were estimated at US$512million. CONCLUSION: This paper provides evidence that CarbSmart is effective in improving behavioral indicators of self-management outcomes in Australians living with diabetes. PRACTICE IMPLICATIONS: CarbSmart has the potential to prevent diabetes-related complications. However, not engaging people living with diabetes with lower levels of patient activation at baseline was recognized as a future opportunity to improve the impact of our service. Strategies are needed to engage people with lower activation levels to improve outcomes in vulnerable and at-risk populations. FUNDING: The development of CarbSmart was funded by Diabetes WA, the national implementation of CarbSmart by the National Diabetes Services Scheme, an initiative of the Australian Government.

Identifying Active Ingredients, Working Mechanisms, and Fidelity Characteristics Reported in Smoking Cessation Interventions in Dutch Primary Care: A Systematic Review.

BACKGROUND: Evidence-based smoking cessation interventions provided by healthcare professionals can be successful in helping citizens to quit smoking. Yet, evidence is needed about the active ingredients of these interventions, how these ingredients work and how they are implemented in practice. Such knowledge is required to effectively support healthcare professionals to optimally put evidence-based smoking cessation interventions to (inter)national practice. OBJECTIVE: To identify active ingredients (including behavior change techniques), mechanisms of action and implementation fidelity reported in smoking cessation interventions in Dutch primary care settings and to relate these to intervention effectiveness. METHODS: A systematic review was conducted by searching nine national intervention or funding databases, five international scientific databases and consulting 17 national smoking cessation experts. Out of 1066 identified manuscripts, 40 interventions were eligible for this review. Based on published protocols, information regarding behavior change techniques and mechanisms of action was systematically abstracted. Additionally, information regarding study characteristics and other active ingredients, effects on smoking behavior and implementation fidelity was abstracted. Comparative effectiveness concerning abstracted intervention characteristics was qualitatively explored. RESULTS: Active ingredients, mechanisms of action and implementation fidelity were moderately to poorly reported. Interventions applying behavior change techniques and interventions with a single behavioral target (i.e. smoking-only versus multiple behaviors) seemed to provide stronger evidence for successfully changing smoking behavior. CONCLUSION: Attention to and reporting on interventions' active ingredients (e.g. behavior change techniques), mechanisms of action and implementation fidelity are prerequisites for developing more effective evidence-based smoking cessation interventions to be successfully implemented in primary healthcare. IMPLICATIONS: This systematic review provides an overview of smoking cessation interventions in Dutch primary care settings, identified since the year 2000. Smoking cessation support is offered in various forms, but our qualitative findings show that interventions including more behavior change techniques and interventions targeting only smoking cessation (compared to multiple behaviors) might be more effective. Results also show that-based on available intervention reports-it is difficult to distinguish patterns of active ingredients (such as behavior change techniques), mechanisms of action and fidelity of implementation in relation to interventions' effectiveness. This means (quality of) reporting on these intervention characteristics should improve.

An intervention designed to investigate habit formation in a novel health behaviour.

OBJECTIVES: Understanding how to help people form habits is important in improving health interventions. The impact of two behaviour change techniques on behaviour (cues and monitoring) was tested, and the role of psychosocial factors that may predict behaviour change and habit formation were investigated. Methods: Participants (N = 186) were randomised to one of six conditions (behaviour monitoring vs habit monitoring vs irrelevant behaviour monitoring and cued vs not cued) and instructed to engage in a specific, novel behaviour every day for the following 3 weeks. Participants completed measures of behaviour, habit strength, prospective memory, attitude, intention, self-efficacy and motivation at three time points (pre-, post- and one-week follow-up). Results: All participants increased habit strength and behaviour. Post-hoc, it was found that community members, compared to students, developed stronger habits and maintained the behaviour and habit strength at one-week follow-up. Intention, behaviour and habit strength post-intervention moderated behaviour and habit strength maintenance. Conclusion: This research furthers our understanding of how to help people form healthy habits. It was found that any intervention seems to be effective in forming a habit and changing behaviour. Moreover, intention, habit and behaviour were the most important predictors of behaviour change and habit formation maintenance.

The Asia Pacific Disaster Mental Health Network: Setting a Mental Health Agenda for the Region.

Addressing the psychological mechanisms and structural inequalities that underpin mental health issues is critical to recovery following disasters and pandemics. The Asia Pacific Disaster Mental Health Network was established in June 2020 in response to the current disaster climate and to foster advancements in disaster-oriented mental health research, practice and policy across the region. Supported by the World Health Organization (WHO) Thematic Platform for Health Emergency and Disaster Risk Management (Health EDRM), the network brings together leading disaster psychiatry, psychology and public health experts. Our aim is to advance policy, research and targeted translation of the evidence so that communities are better informed in preparation and response to disasters, pandemics and mass trauma. The first meetings of the network resulted in the development of a regional disaster mental health agenda focused on the current context, with five priority areas: (1) Strengthening community engagement and the integration of diverse perspectives in planning, implementing and evaluating mental health and psychosocial response in disasters; (2) Supporting and assessing the capacity of mental health systems to respond to disasters; (3) Optimising emerging technologies in mental healthcare; (4) Understanding and responding appropriately to addressing the mental health impacts of climate change; (5) Prioritising mental health and psychosocial support for high-risk groups. Consideration of these priority areas in future research, practice and policy will support nuanced and effective psychosocial initiatives for disaster-affected populations within the Asia Pacific region.

Predicting what mothers feed their preschoolers: Guided by an extended theory of planned behaviour.

BACKGROUND: Healthy eating behaviours are important for physical and mental well-being and developing healthy eating behaviours early in life is important. As parents are the main providers of preschool children's food the main objective of this study was to use the theory of planned behaviour, expanded to include habit and past behaviour, to predict parents' healthy feeding intention and behaviour. METHODS: Theory of planned behaviour, habit strength, and past behaviour were reported at baseline by 443 mothers. One week later, 235 mothers completed a healthy feeding questionnaire on the eating behaviours of their 2-4 year old child. Data were analysed using hierarchical regression analyses to predict parent's general healthy feeding behaviour, and five sub-behaviours: parents' perceptions of their child's fruit and vegetable consumption, healthy and unhealthy snacking behaviour, as well as healthy and unhealthy drinking behaviour. RESULTS: Intention, perceived behavioural control, habit strength and past behaviour were all positively associated with parents' general healthy feeding (47% explained variance). Perceived behavioural control was the only variable positively associated with mothers' perception of their child's fruit and vegetable consumption and unhealthy snacking behaviour. The theory did not explain the other behaviours. Moreover, habit strength only strengthened the intention-behaviour link for fruit and vegetable consumption and child's age was only positively associated with the mothers' perception of their child's unhealthy snacking behaviour. DISCUSSION: The findings suggest important differences in the predictors of different feeding behaviours that can provide direction for future intervention development.

Food healthiness versus tastiness: Contrasting their impact on more and less successful healthy shoppers within a virtual food shopping task.

A virtual shopping task was employed to illuminate why women who intend to shop healthily are differentially successful in doing so. Female undergraduates (N = 68) performed a modified approach and avoidance task that employed food items differing in healthiness and tastiness, and yielded relative speed to select and reject food items in a stylised supermarket. Participants categorised a food item either in terms of healthiness or tastiness, then pulled (selected) or pushed (rejected) the item using a joystick. Participants showed faster selection of tasty food after categorisation in terms of tastiness, irrespective of the food's healthiness. However, after categorisation in terms of healthiness, only more successful healthy food shoppers showed faster selection of healthy items regardless of tastiness. Less successful healthy food shoppers showed this effect only for tasty food, and displayed faster rejection of food items not considered tasty, regardless of their assessed healthiness. Thus, when participants who reported the greatest gap between their shopping intention and shopping behaviour were judging the healthiness of food items, their speed to select and reject items continued to be influenced by tastiness. This suggests that reducing incidental processing of food tastiness may reduce the intention-behaviour gap in healthy food shopping.