Digital Health Week

Telehealth and the new normal: using electronic patient data to study its impacts on care activities within general practice during the COVID-19 pandemic

Rae-Anne Hardie — 2023-12-19

Title: Telehealth and the new normal: using electronic patient data to study its impacts on care activities within general practice during the COVID-19 pandemic

Background: Telehealth has provided a practical mode of care delivery in Australian general practice since its rapid implementation in 2020. While widely utilised, limited data exists on how telehealth has impacted general practice activities. This may impact on the delivery and quality of care

Aims: To investigate several facets of telehealth in general practice: general practitioners’ perspectives, medication prescribing rates, diagnostic testing, utilisation in residential aged care facilities (RACFs), and care for chronic conditions (e.g., diabetes and mental health).

Methods: Mixed methods study including qualitative ‘Action Research’ focus groups, and quantitative retrospective observational study of routinely-collected electronic patient data from 807 general practices across New South Wales and Victoria, comparing periods before (from January 2019) and after the March 2020 introduction of MBS telehealth funding.

Results: Telehealth has had several key benefits for general practice, including access to care for RACF residents, high uptake for monitoring of Type 2 diabetes patients, and practice benefits (funding and safety). Potential barriers included quality of care (lower pathology referral and prescribing rates, quality of antibiotic prescribing) and technology (lower video uptake). A key factor was evolution of telehealth, which has been driven by adaptations to changes and MBS funding.

Conclusions: This study emphasises the importance of several key areas where telehealth can deliver the greatest value (chronic disease monitoring, access to care) as well as factors that should be considered for quality improvement, from infrastructure to workflows (pathology ordering, medication prescribing, technology barriers, funding changes). These lessons learnt may improve digital care delivery.

“I hate messages that have nothing to do with me”: Co-design of text messages to engage adolescents with health apps

Louise Thornton — 2023-12-19

Background: Engagement with ehealth interventions is often low, even among adolescents. To be effective, development of strategies to better engage adolescents with eHealth approaches must involve adolescents themselves.

Aims: This study aimed to meaningfully engage young people in the production of text messages to prompt adolescents to engage with a healthy lifestyles app (Health4Life).

Methods: With assistance from a senior researcher, two Young Person Research Assistants developed and conducted an online consultation via Zoom with Adolescent Expert Advisors. They then used advisors’ feedback to generate text messages designed to engage adolescents with the Health4Life app.

Results: Twenty-five adolescents attended the online consultation. While none of the adolescents chose to speak or share video during the consultation, they were highly engaged with online activities and provided detailed feedback via the chat. Adolescents expressed preferences for: relatable and personable quotes; positive, relatable messages including health facts; and delivery at 6-8am or 8-9pm. A final library of 20 text messages was produced that will be implemented in upcoming studies examining adolescents’ health app engagement.

Conclusions: Employing Young Person Research Assistants to lead this research, in addition to engaging Adolescent Expert Advisors, meant young people were meaningfully involved in every stage of this research and resulted in a library of engaging and relevant text messages to prompt adolescent engagement with health apps. This study also generated important insights regarding how to effectively engage adolescents with research. For example researchers might consider using asynchronous methods for gaining feedback from this population (e.g. group chats).

Perinatal support for breastfeeding using mHealth: A mixed method feasibility pilot of the My Baby Now app

Heilok Cheng — 2023-12-19

Background: The antenatal period provides an opportunity to support mothers’ infant feeding decisions. Breastfeeding provides well-established benefits for infants and mothers; however, breastfeeding rates are low. Breastfeeding interventions may target breastfeeding intentions, confidence and attitudes. Few studies have explored the impact of antenatal mHealth interventions. The My Baby Now (MBN) app provides evidence-based infant feeding information and continuous support to parents.

Aims: Examine the impact of the MBN app on breastfeeding knowledge, intention, confidence and attitudes across the perinatal period.

Methods: A mixed-method pre-post pilot study was conducted in 2021. The MBN app was offered to first-time mothers between 20-30 weeks gestation. Mothers completed surveys at baseline (T1), 36-38 weeks gestation (T2) and 8-12 weeks post-partum (T3), measuring breastfeeding knowledge, intentions, attitudes and confidence. App engagement was measured via app analytics. Qualitative interviews were conducted post-T3 with a purposeful sample.

Results: Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education perceived the app to be higher quality, more useful and impactful, than mothers with university education. From T1-T2, breastfeeding knowledge and exclusive breastfeeding intentions increased significantly. Breastfeeding attitudes and confidence increased significantly across T1-T2 and T1-T3. Level/intensity of app engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 amongst mothers without university education, but did not predict changes in breastfeeding knowledge, confidence or intentions.

Conclusions: The MBN app provided an acceptable source of breastfeeding support, particularly for women without university education. Further randomised controlled trials should examine MBN effectiveness on breastfeeding outcomes.

How does collaboration support sexual health organisations to successfully navigate Meta’s content moderation policies?

Joanna Williams — 2023-12-19

Background: Since the start of the COVID-19 pandemic, sexual health organisations increasingly use social media platforms (particularly Instagram) to distribute sexual health content to young people. However, Meta’s content moderation policies severely restrict the distribution of ‘sexual’ content that is ‘sexual’, which restricts the ability of sexual health organisations to distribute content that reflects peoples’ lived experiences.

Aims: This study examines how sexual health organisations resist and creatively navigate Meta’s content moderation policies to ensure that their distributed content reaches young people.

Methods: This exploratory study involved semi-structured interviews with producers of best-practice digital sexual health promotion employed by 12 sexual health organisations in Australia and the United Kingdom. Interviews focused on understanding professional experiences of producing and distributing social media content. Themes were developed using abductive analysis.

Results: Many of the sexual health organisations collaborated with content creators and organisations, who hold similar values to that organisation. These relationships are used to distribute content to new networks, prioritise content within Instagram’s algorithm and share experiences of content moderation. Collaboration supports organisations to better understand the nuances of the algorithm and produce content that more effectively flies under the radar of content moderation.

Conclusions: While Meta’s content moderation policies restrict the type of sexual health content shared, sexual health organisations use collaboration to increase their visibility with young people on Instagram. These strategies can be used to increase the visibility of digital health content, that resonates with young people’s lived experiences, across a variety of social media platforms.

Evaluating the usability of Electronic Medication Management Systems (EMMS) during design and redesign: Time to consider new approaches

Selvana Awad — 2023-12-19

Title: Evaluating the usability of Electronic Medication Management Systems (EMMS) during design and redesign: Time to consider new approaches

Background: Electronic Medication Management Systems (EMMS) support the prescribing, review and administration of medications. Poor EMMS usability can result in inefficiencies and use errors which may lead to patient harm. The application of human factors methods can support the usable and safe design of EMMS.

Aims: To identify human factors methods that have been used to evaluate the usability of hospital EMMS during design or redesign.

Methods: A systematic review, following PRISMA guidelines, was conducted by searching online databases and relevant journals from January 2011 to May 2022. Studies were included if they described the application of human factors methods to evaluate the usability of EMMS during design or redesign.

Results: Nineteen papers met the inclusion criteria and these described 12 human factors methods to evaluate the usability of EMMS designs. The most frequently used were prototyping, usability testing, participant surveys/questionnaires and interviews. These generally aimed to identify usability issues, heuristic violations and design enhancements. Only one paper utilised a safety-oriented method and one, a mental workload assessment method.

Conclusions: While the review identified 12 methods used to evaluate the usability of EMMS designs, these reflect only a subset of available methods. Given the high-risk nature of medication management in complex hospital environments, and the potential for harm due to poorly designed EMMS, there is significant potential to apply methods that aim to identify safety-critical issues during usability evaluations.

Embedding Digital Therapeutics into Primary Care: A New Era of Prescribing and Dispensing

Janet M.Y Cheung — 2023-12-19

Background: The current practice and resource constraints in primary care make the management of mental health and sleep disturbances amenable to digital health interventions (DHIs). However, the enablers and barriers for practice translation has not been concurrently explored across key primary care healthcare professionals (HCPs)

Aims: To explore primary care HCPs attitudes towards DHIs and perceived readiness for practice integration.

Methods: Secondary analysis of two qualitative datasets collected from HCPs enrolled in a clinical trial evaluating SleepFix, an app-based intervention for insomnia. Interviews were guided by a schedule of questions focusing on HCPs current use of DHIs, perceived practice barriers/enablers of implementation, user experience of SleepFix and potential models of care for integrating DHIs into practice. Interviews were transcribed verbatim and thematically analysed.

Results: 45 HCP participants (GP=17, nurse =14, pharmacist=14) were interviewed pre-intervention and 15 (GP=6, nurses=2, pharmacist=1) at post-intervention. While participants appeared more receptive towards using DHIs post-pandemic, they did not feel primary care was ready for embedding DHIs, especially sleep-based interventions, into mainstream care. Participants reiterated the need for reliable point-of-care formularies for DHIs to guide practice. Further, in response to the lack of clarity for how DHIs mapped to the respective professions’ scope of practice and reimbursement structures alternative care models were articulated.

Conclusions: While DHIs show promise for improving patient care, establishing a robust evidence-base and revising the respective professions’ scope of practice scope and reimbursement are necessary.

The impact of app engagement in an intervention addressing parents’ fussy eating concerns

Brittany Markides — 2023-12-19

Background: Although fussy eating is a developmentally normal behaviour, it is a source of anxiety and concern for up to half of parents of young children. Concern for fussy eating mediates parents’ use of nonresponsive feeding practises, which have poor, long-term health outcomes for children. However, few interventions have been developed for this population.

Aims: This randomised controlled feasibility trial evaluated a web app to improve feeding practices of parents concerned for fussy eating.

Methods: A web app was co-designed with parents of toddlers concerned about fussy eating. The final app included a food offer tracker, information about fussy eating/feeding strategies, recipes, and SMS. Participants were recruited via Facebook and randomised to intervention (n=25, received app access for 6 weeks) or control (n=26, wait-listed). T-tests evaluated pre/post differences in parent feeding practices and child eating behaviours; app engagement impact on outcomes was investigated with linear regression.

Results: No pre/post differences were found in the control group. Parents in the intervention reported significant decreases in children’s food fussiness (p = 0.04, Cohen D = 0.40) and aggressive mealtime behaviours (p = 0.01, Cohen D = .55). Higher app engagement predicted decreased parental concern for fussy eating (R2 = 0.77, F = 24.48, p = 0.03) and increased structured parent feeding practises (R2 = 0.52, F = 6.71, p = 0.0004).

Conclusions: A web app co-designed with parents to address their fussy eating concerns has potential to improve their feeding practices. A larger trial is warranted to examine long-term impacts.

Emerging health professions and future-proof skillsets for health professionals: a qualitative study

Xue (Snow) Li — 2023-12-19

Title: Emerging health professions and future-proof skillsets for health professionals: a qualitative study

Background: Healthcare systems around the world are facing urgent and continuous challenges. In parallel with the challenges outlined above, rapid advancement in biomedical research and technologies also bring possible novel solutions. It is in this context that future healthcare needs and emerging health professions need to be considered.

Aims: This research paper aims to identify emerging health professions and future-proof skillsets for health professionals from the perspectives of healthcare leaders.

Methods: A qualitative study employing online interviews and grounded theory methodology to identify emergent themes. 17 healthcare leaders from four countries participated in this study.

Results: Study participants identified five emerging health professions: eHealth specialist; biomedical informatician; wellbeing coach; multidisciplinary health specialist; and community health navigator. Eight key skillsets common to all healthcare professions were identified, including: digital and data health literacy; health system knowledge; genomic literacy; health finance literacy; innovation and entrepreneurship; teamwork; communication; and problem-solving.

Conclusions: This study provides essential groundwork for healthcare leaders to map out training needs for the health workforce of the future. Further research as well as consultation with governments, healthcare providers and educational institutions is needed to help identify optimal health professional training pathways that align with future health care needs, both nationally and globally

The quality of training data for mammographic AI systems: investigating factors to reduce hype and increase clinical translation

Zhengqiang Jiang — 2023-12-19

Background: Breast cancer is one of leading causes of female cancer-related death, with 25-30% of the total new cancer cases in women annually and AI breast screening has demonstrated promising detection results. High quality digital health data are required to train a reliable and effective AI model for breast cancer however different radiologists have different experience in lesion segmentation and levels of agreement for lesion location. Aims: This study aims to evaluate the AI systems by analyzing the quality of data with concordance between annotations of radiologists.

Methods: MIAS Mammography Dataset (320 images, 33% cancer cases, 1 radiologist annotating cancers) and Lifepool (856 images, 2 radiologists) were used with data from overlapped annotations using Lin’s concordance correlation coefficient (CCC) ‘almost perfect’ category. An AI system which applied deep convolutional neural networks to detect breast cancer was implemented.

Results: The validation accuracy for training and testing the AI system with data from the combination of MIAS and ‘almost perfect’ Lifepool datasets is higher (0.95 versus 0.9 training; 0.97 versus 0.9 testing). In addition, the training process of the AI system from the combination datasets outputs higher validation accuracy in an earlier epoch, which indicates less training computation time to train the accurate AI system.

Conclusions: AI system performance is affected by the concordance within the training data, with ‘almost perfect’ data yielding more accurate cancer detection and reduce training time. Future work will investigate other training data in the level of ‘substantial’, ‘moderate’ and ‘poor’ for AI performance to map the noise within the system.

A consumer co-designed, self-delivered, Avatar-based patient discharge education application improves acute coronary syndrome (ACS) patient knowledge

Ling Zhang — 2023-12-19

Title: A consumer-co-designed, self-delivered, Avatar-based patient discharge education application improves acute coronary syndrome (ACS) patient knowledge

Background: High 30-day rehospitalisation rates among ACS patients have been attributed to poor disease knowledge and self-care, especially in those with low literacy and health literacy. Traditional patient education methods fail to address these issues.

Aims: We aimed to develop and evaluate a consumer-co-designed discharge education application (app) and test its effectiveness on disease knowledge and acceptability.

Methods: Based on the Heart Foundation Six Steps to Cardiac Recovery the app underwent a rigorous development process with the substantial engagement of consumers (Figure 1). It was piloted in patients with unstable angina or a non-STEMI episode. Disease knowledge, ACS responses were assessed at baseline, followed by first use and one month later. Patients and cardiac nurses rated the acceptability.

Results: Among 22 participants; 81.8% were male, mean age 59.7 years; 45.5% had not completed high school and 25% had marginal health literacy.

Significant improvements were observed for overall disease knowledge at one month (p=.003) and for the exercise and nutrition domains at discharge (p=.029; p<.001) and one month (p=.02; p=.003) (Figure 2). Significant improvements were also observed for ACS knowledge and beliefs at discharge (p=.008; p=.038) and one month (p<.001; p=.025) when ACS response attitude was also significantly improved at one month (p=.036). The app had very high acceptability, and was described as ‘clear, simple, easy to understand, stimulating and interactive, better than a live person’.

Conclusions: This novel ACS education app has the potential to provide discharge education for ACS patients even for patients with low education and health literacy.

The Youth Engagement Study (YES!): How can we optimise adolescent participation in chronic disease prevention research?

Mariam Mandoh — 2023-12-19

Background: Adolescent participation in decision-making is now widely accepted to enhance chronic disease prevention research and intervention development. However, optimal modes to engage adolescents, particularly in the digital age remains unknown.

Aims: To identify a) how adolescents perceive youth participation, b) barriers and facilitators to participation c) how adolescents want to be engaged in chronic disease prevention decision-making.

Methods: Two phases between Feb-July-2022: 1) digital cross-sectional survey, 2) digital focus groups. Eligible participants were 13-18 years-old and living in Australia. Quantitative and qualitative data were analysed using descriptive statistics and thematic analyses, respectively.

Results: Overall, 520 participants completed the study (cross-sectional survey n=501, focus groups n=19; mean age 16 years SD1.2, 60% (319/520) female, 37% (194/520) culturally and linguistically diverse and 23% (121/520) lived rurally. Twenty percent (100/501) reported engagement in health promoting activities. Those who had not been involved reported ‘lack of opportunity’ (>60%, 171/278) as the major barrier to participation. Furthermore, 45% (227/501) of participants reported ‘hybrid’ participation combining digital and face-face components as preferred delivery method. Adolescents reported that participatory methods such as co-design, advocacy, leadership and advisory groups (42%, 213/501) would provide the most influence over health promoting activities for adolescents. Focus group data established a need for digital participatory methods to permit flexibility and accessibility.

Conclusion: This digital study enabled the inclusion of a diverse sample of adolescent participants from across Australia. Findings suggest adolescents are rarely engaged in health promoting activities that affect them. Identified barriers need to be addressed to ensure meaningful engagement.

The use of digital health to communicate medication and health-related goals of care for older people with polypharmacy

Lisa Kouladjian O'Donnell — 2023-12-19

Background: Identifying goals of care of older people can optimise health and medication management, however these conversations are often sidelined due to several barriers. Digital health has the potential to allow individuals to communicate their goals of care to their healthcare practitioners, however little is known about the preferences of older adults.

Aim: To explore digital technologies that older people would prefer to use to document and communicate their health and medication-related goals of care.

Methods: A questionnaire was developed to explore the preferences and types of digital technologies older people (≥65 years) would use to communicate their goals of care. Questions included exploring older adults’ willingness to use digital technologies and their preferred options. The questionnaire was administered within two settings: a) hospitalised older adults admitted to Royal North Shore Hospital, and b) community-dwelling older adults. Responses were analysed descriptively.

Results: Currently, the questionnaire has been completed by 24 hospitalised and 70 community-dwelling older adults, mean(SD) age 76.4(7.3) and 74.7(7.0), respectively. Community-dwelling older people (n=44, 63.9%) were more willing to using digital health to document goals of care compared with hospitalised older adults (n=13, 54.2%). Both community-dwelling and hospitalised older adults expressed that Email (n=25(43.9%), n=5(15.6%)) and Websites (n=11(19.3%), n=8(25%)) were the preferred options to communicate goals of care to their healthcare practitioners.

Conclusions: Preliminary results suggests that older people are willing to document and communicate their goals of care using digital health technologies.

Positive Choices: Evaluation of a national initiative to disseminate evidence-based alcohol and other drug education and wellbeing resources.

Emma Devine — 2023-12-19

Title: Positive Choices: Evaluation of a national initiative to disseminate evidence-based alcohol and other drug education and wellbeing resources.

Background: Alcohol and other drug (AOD) use among Australian adolescents continues to be a public health concern, and early use puts young people at higher risk of subsequent negative outcomes. Research shows that both school-based prevention strategies and parenting strategies are effective at reducing AOD use and their related harms. However, such strategies are often not implemented. Positive Choices is a website developed to address this evidence-practice gap by providing school staff, parents, and students with access to evidence-based drug education resources. Aims: To evaluate the effectiveness of the Positive Choices website.

Methods: Online questionnaires were administered to school staff and parents/caregivers. The evaluation was guided by the GoodWeb framework which assesses attributes relevant to e-health websites, including appearance, content, ease of use, interactivity, and technical adequacy.

Results: 43 school staff and 53 parents/caregivers completed the online questionnaire. Overall, Positive Choices performed well. Of the website attributes evaluated, appearance was rated highest by participants, followed by ease of use and content, while interactivity was rated lowest. 93% of school staff and 94% of parents were satisfied with Positive Choices and would recommend the portal to a friend or colleague.

Conclusions: Findings from the evaluation of Positive Choices demonstrate that it is effective at disseminating evidence based AOD education resources to school staff and parents. The findings further highlight the important role of online health initiatives for AOD harm reduction.

Getting off the Universal Serial Bus (USB) – An Innovative Approach to Nursing and Midwifery Recruitment

Dan Shaw — 2023-12-19

Background: In 2020, an application for funding was successful for the development of a digital solution, building on a pilot at the Prince of Wales Hospital (POWH). Given the current pandemic response environment, there is a critical need to develop an industry leading Nursing and Midwifery skills development approach, enabled by emerging technology. Currently Nursing orientation and information on-boarding processes at SESLHD are not standardized. Med App is an offline-accessible, mobile-first tool for accessing clinical and hospital guidelines, communicating with clinicians, and facilitating education and training. It offers an innovative digital solution to support not only Orientation, but also staff education, quality improvement, real-time clinical decision support and communication. Across SESLHD the tool has been trialed in a COVID-19 testing clinic, Vaccination Hub, with Nursing and Midwifery Graduates and most recently, with a nursing and midwifery casual staffing office.

Aims: To address the growing healthcare system pressures requiring remote and innovative ways of delivering education and information to clinicians, enhancing access to information and education in a way that provides an alternate medium to interact with educators, teams and colleagues.

Methods: Rollout via New Graduate coordinators to 2021 new Graduate Nurses and Midwives prior to commencement of graduate program. Mixed method evaluation focusing on a time in motion study, interviews, focus groups and surveys will explore the experiences of participants.

Results: To date, over 300 users across 7 SESLHD facilities with 859 hours of productive time returned to practice. Next steps include the launch of a Falls Quality Improvement project and a Wellbeing Initiative using a Wellbeing Index.

Conclusions: With a formal evaluation underway, early data shows strong engagement with the platform by both users and coordinators with anecdotal data further demonstrating the value of timely access to information in a rapidly changing world.

The ethics of sextech – is design justice compatible with market demands?

Kath Albury — 2023-12-19

Background: While many sextech projects involve researchers, to date these partnerships have primarily focused on the biomedical or sexological aspects of sexuality and tech use. This paper explores sociotechnical insights drawn from an online 'public interest sextech' research hackathon, which featured presentations from representatives of marginalised communities disproportionally impacted by the collection, regulation, aggregation and commercialisation of sexual and/or intimate data – including Aboriginal and Torres Strait Islander people, people living with HIV, people with disabilities, trans people and sex workers.

Aims: Hackathon participants (including sexuality educators, design professionals and technologists) were asked to consider how the values of designers become embedded in the technologies; and invited to create speculative designs for innovative sextech informed by design justice approaches (Costanza-Chock 2020).

Methods: Hackathons typically involve a series of intensive design sprints. We followed this model, supporting participants via expert presentations, and access to industry mentors over a 3-day period. Participants then ‘pitched’ their design to judges with broad expertise in sextech and public interest technologies. They also shared reflections on speculative sextech design (and the broader hackathon experience) in facilitated small group sessions.

Results: Throughout the hackathon, panellists (and activist participants) focused on local, collective approaches – focusing on cultural protocols, counter-surveillance and building community partnerships. In contrast, market-focused participants prioritised opportunities for commercialisation and global scaleability.

Conclusions: While co-design is a core element of ethical and inclusive practice, there are significant tensions between the market demands of start-up tech cultures, and the more collective approaches favoured by stakeholders from marginalised sexual communities.

Digital Health as a silver lining: exploring pregnancy digital health usage amidst the COVID-19 pandemic

Natasa Lazarevic — 2023-12-19

Background: Digital health tools such as apps are being increasingly used by women to access pregnancy-related information.

Aims: Conducted during the COVID-19 pandemic, this study investigated pregnant women’s usage of digital health tools and self-monitoring behaviours. In addition, views and interest in theoretical pregnancy app features: (1) a direct patient-to-healthcare-professional communication tool and (2) a novel body measurement tool was assessed.

Methods: Using a mixed methods approach, 108 pregnant women were surveyed and 15 currently or recently pregnant women were interviewed online between November 2020 to May 2022.

Results: We found that the COVID-19 pandemic had far-reaching impacts on the experiences of pregnant women – from their experiences with healthcare to their relationships with themselves and their social circle. Most participants said that they would use the theoretical app features we described and also identified a gap in the availability of evidence-based educational information. Other features that they would include in a pregnancy app were a “Digital Wallet” and a desire for a holistic pregnancy app that allowed for more continuous and personalised care. The main factor that influenced how likely participants were to use pregnancy apps were concerns about data privacy and security.

Conclusions: This study highlights the gaps and needs of pregnant women and should inform all stakeholders designing pregnancy digital healthcare. This study offers a unique insight into the experiences of pregnant women during a very particular and unique period in human history.

Electronic Medical Record Implementation Incentivises Accurate Patient Identifier Entry for Point-of-Care Glucose Measures: Another Step Towards Improved In-Hospital Diabetes Care

Rahul Barmanray — 2023-12-19

Title: Electronic Medical Record Implementation Incentivises Accurate Patient Identifier Entry for Point-of-Care Glucose Measures: Another Step Towards Improved In-Hospital Diabetes Care

Background: Clinical service delivery and research in the field of inpatient diabetes care is contingent on accurate documentation of point-of-care glucose results. Networked glucose meters require correct patient identifier entry to link glucose data with a patient’s chart.

Aims: To evaluate accurate entry of patient identifiers using a networked glucose meter system, before and after implementation of an electronic medical record.

Methods: This retrospective observational study evaluated glucose meter patient identifier entry at a quaternary hospital in Victoria, Australia from September 2019 (introduction of networked blood glucose meters), until May 2021, 9 months following hospital-wide EMR implementation. Identifier entry was considered accurate if string length matched the length of the identifier type in use. The four weeks following EMR implementation were censored to account for peri-implementation workflow disruptions.

Results: Over 79 weeks, 76.3% of glucose measures (269,199/352,841) had accurate patient identifier entry. Pre-EMR entry accuracy was 71.6% (132,918/185,677) while post-EMR accuracy was higher at 81.5% (136,281/167,164), p<0.001. Interrupted time series modelling showed the deterioration in identifier entry accuracy observed from program inception (slope -0.20 percentage points/week) transformed to a marked and sustained improvement following EMR implementation (slope +0.36 percentage points/week, p<0.001).

Conclusions: While patient identifier entry accuracy deteriorated pre-EMR, post-EMR improvements may relate to aligning incentives in this period. Pre-EMR entry accuracy was not incentivised, whereas post-EMR accurate entry resulted in automatic glucose data transfer to the clinical record, saving the frontline clinician time and effort. These results have implications for human-centred electronic workflow design and implementation, to optimise delivery of in-hospital diabetes care.

Evaluation, quantifying and minimising the carbon footprint of inhalational anaesthesia in operation theatres at the Children’s Hospital at Westmead.

Reza Kahlaee — 2023-12-19

Background: Inhalational anaesthetic agents, particularly Nitrous, have significant global warming effects. We are uniquely positioned to minimise our carbon footprint through the change of conduct of practice. To quantify the local significance, we undertook an audit of CHW’s inhalational anaesthetic usage over the past 12 months to quantify both the carbon footprint (in equivalent tonnes of CO2) and the monetary cost of our inhalational anaesthetics. The Nitrous carbon footprint was significantly greater than that of the volatile agents, and the financial cost was not insignificant. This data highlights the potential for significantly reducing our department’s carbon footprint by minimising Nitrous use and limiting fresh gas flows. A significant portion of this consumption likely occurs at the point of gas induction which creates a point of practice change that could have significant reductions in overall gas usage.

Aims: Minimising the carbon footprint of inhalational anaesthesia at the Children’s Hospital at Westmead (CHW), Creating a database (DB) for ongoing access to anaesthesia/surgical data for future research purposes.

Methods: Physiological data, anaesthetic volatiles, Nitrous, and medical air used in all anaesthesia-induced operations were captured, anonymised and restored in a DB using anaesthetic machines and electronic monitors in surgical wards at CHW from 15.10.2021-15.10.2022.

Results: Recent rationalisation in volatile anaesthetic consumption at Royal North Shore Hospital (RNS) achieved a 12-month change of 66% reduction in eCO2 and $82000 reduction in the direct cost of volatiles (39.3). For comparison, RNS does ~20000 cases per year (baseline ~1200 tonnes eCO2 footprint), and CHW does ~15000 cases per year (baseline ~2300 tonne eCO2 footprint).

Conclusions: Similar changes implemented at CHW would be equivalent to an over 1,500-tonne reduction in eCO2 and over $165,000 in direct cost savings each year.

Making Inroads: Trial of An Online Early Intervention To Address Co-Occurring Anxiety And Alcohol Use Problems Among Young People

Katrina Prior — 2023-12-19

Background/Aims: The transition to adulthood is a unique period characterised by numerous role changes and increased opportunities for alcohol consumption. Using alcohol to cope with anxiety symptoms is common, and young people with anxiety are at a greater risk of risky alcohol use and progression to alcohol use disorder. A randomised controlled trial was conducted to evaluate the efficacy of the Inroads program, an internet-delivered early intervention that targets anxiety, alcohol use, and the interconnections between these problems.

Method: Participants (aged 17-24; n=123) experiencing anxiety symptoms and harmful alcohol use were randomised to Inroads or a psychoeducation control. The Inroads intervention comprised 5 online CBT modules and weekly therapist support via email or phone. Primary outcomes assessed 2- and 6-months after baseline were standard drinks consumed in the past month, severity of alcohol-related consequences, and anxiety symptoms. Secondary outcomes were social anxiety and alcohol expectancies. Analyses were intention-to-treat using multi-level modeling for repeated measures.

Results: The Inroads program reduced anxiety and corrected alcohol expectancies relative to control. Alcohol consumption and related consequences reduced in both conditions; however, benefits were greater and sustained at 6 months for participants in the Inroads condition.

Conclusion: The study is the first to evaluate the benefits of early intervention to interrupt the trajectory to co-occurring anxiety and alcohol use disorders. The online format combined with therapist support is aligned with youth treatment preferences, and has the potential for wide dissemination to reach those who are not able or willing to access face-to-face treatment.

The Future Technology in Patient Reconstructive Surgery: 4D printing.

Amir Fahimipour — 2023-12-19

Purpose: Bone augmentation is a procedure in a patient who has been affected by tissue defects. The
aim of this study is to demonstrate which technique and materials are suitable for tissue
reconstruction by using novel printing technologies.

Methodology: A literature search was performed using the PubMed and Medline databases, with the
keywords of ((((((3D printing) AND (4d printing)) OR (5d printing))) AND (materials))
AND (techniques)) AND (surgery) has performed. A total of 18 papers were included in the
following review until March 2022.

Results: Shape-memory polymers using in recent bioprinters are useable as the prosthesis’s
fabrications due to the treatments of patients in reconstructive surgeries. These methods
exhibit the precise hard and soft tissue implanted in orthopedic sites as well as the oral and
maxillofacial region. 3D and recent 5D printed tissue grafts permit precise design in complex
human body defects, due to trauma or cancer. The accuracy to cover the defect, modified
these techniques, from the range of diagnostics towards ultimate treatment plans, for a
patient; with the feature of less post-operative discomfort and expedited human body tissue
healing.

Conclusion: Recent research on different techniques of multi-dimension applications have shown positive
results in the tissue engineering field, which needs more researches in the case of quality,
efficiency, and accessibility to surgeons.

Remote assessment of gait and balance of people with Parkinson’s disease – a reliability study

Paulo Pelicioni — 2023-12-19

Background: Due to COVID-19, the use of telehealth increased exponentially. However, despite this increase in the use of telehealth, clinicians lack reliable tools to assess the balance and gait of people with Parkinson’s disease (PD).

Aims: investigate the reliability of balance and gait assessments undertaken remotely via telehealth in people with PD.

Methods: 29 people with PD performed 14 tests of balance and gait twice: (i) face-to-face, and (ii) remotely, via videoconference (which was also recorded) between 7 and 14 days after. The tests included items from the Berg Balance Scale, Functional Gait Assessment, and the Timed-Up-And-Go. We compared face-to-face and live videoconference performance to obtain assessment reliability. One assessor rated the recording at least two weeks after the live videoconference to obtain intra-rater reliability. Another assessor rated the recording in order to obtain inter-rater reliability. Reliability was measured using either intraclass correlation (ICC) two-way mixed with absolute agreement (continuous measures) or Fleiss multi-rater Kappa test (ordinal measures).

Results: Most tests showed moderate to very good assessment reliability between face-to-face and live telehealth (ICC=0.505-1), between face-to-face and recorded telehealth (ICC=0.503-1) and for the inter-rater reliability between the recorded telehealth assessments (ICC=0.557-1). Reliability appeared to be higher in tests involving quantitative rather than qualitative measures of performance. A ceiling effect was noted in some tests where all participants completed tests with maximum scores in both face-to-face and remote assessments.

Conclusions: This study supports the feasibility of some remote assessments via telehealth for people with PD.

The Effect Mechanical Force in Dental Follicle (FEA)

Amir Fahimipour — 2023-12-19

Background: FEA technique is now commonly used to address a variety of important biological questions including assessment of stress and strain distribution in bone, dental implants, orthodontics, and tooth eruption.

Aim: This study is based upon finite element analysis (FEA) that was used to study tooth eruption sequelae.

Methods: The computer modelling approach (ANSYS Workbench V 18.2), applying software to investigate stress and strain of dental follicles, which comprises soft tissues that surround the developing tooth. Different stages for tooth and soft tissue are defined, and the current study examines changes in soft and hard tissues relevant to necessary bone remodelling for tooth eruption to occur.

Results: The association of tooth eruption with root formation, leads to the presence of the root generating compressive and tensile hydrostatic strain in the coronal and apical follicle, as per the Dental Follicle Functional theory. It is shown that there would be compression of coronal DF, and tension of apical DF of the simulated teeth, with inferred bone remodeling leading to tooth eruption.

Conclusions: This new model has appreciable clinical significance. In the first instance, this would account for the static behavior of unerupted impacted teeth, that have lost their polarizing soft-tissue pathway. Further, it should be possible to guide the eruption of teeth, by surgically creating a narrow soft-tissue path.

Avoiding God’s waiting room: Lessons from the lived experiences of older people who use technology to support physical activity

Abby Haynes — 2023-12-19

Background: Digital technologies provide new opportunities to promote, incentivise and support physical activity for healthy ageing, but their potential is yet to be fully realised. There is mixed information about older people’s capacity to use new technologies to support physical activity and about how it can benefit them.

Aims: To explore the characteristics and influences of older people’s ‘successful’ uses of technology to support physical activity.

Methods: We conducted narrative interviews with 17 purposively sampled people aged 70+ who, in a previous survey, reported using technology to support physical activity. We sought to identify transferable lessons from their experiences and to explain how these experiences were shaped by contextual factors, including ageing and the COVID-19 pandemic. Data was analysed inductively and deductively.

Results: Interviewees perceived technology as a facilitator and motivator for physical activity, describing multiple benefits. Many disparaged their technical skills yet used technology creatively to access and enhance physical activity. They were driven by philosophies of active living which underpinned their refusal to “sit in God’s waiting room”. Most reported navigating challenges associated with ageing in a discriminatory society, compounded by COVID-19 impacts. Technology use was influenced by social and health relationships. We identified four ‘lessons’: 1. Embrace technology, 2. Find your thing, 3. Be adaptive and 4. Resist ‘being old’.

Conclusions: Older people’s use of technology to support physical activity may be encouraged by leveraging trusted social and health relationships to model and promote technology-supported physical activity, and strengthening the value proposition of technology via co-design.

A tale of two hospitals: How teams utilise an antimicrobial surveillance tool

Bethany Van Dort — 2023-12-19

Background: Antimicrobial stewardship (AMS) teams utilise digital technologies to improve antimicrobial prescribing practices in hospitals. The majority of digital tools are implemented in NSW hospitals at a district level, however, the work processes of antimicrobial stewardship teams often differ at a hospital level.

Aims: To explore how AMS teams at two hospitals in one NSW local health district (LHD) utilise a digital antimicrobial surveillance tool (Live AMS) and identify factors that promote uptake.

Methods: Observations and interviews were conducted with AMS teams at two public teaching hospitals in Sydney to understand work processes and explore end-user perceptions.

Results: Observations (27 hours) and interviews (n=15) revealed use and level of familiarity with the tool differed between the two hospitals. Despite AMS teams at both hospitals performing similar tasks, Live AMS was utilised more at the hospital where more participants were reportedly involved in the tool’s development. Participants at both hospitals perceived Live AMS to be easy to use. At the hospital where the tool was utilised less, some participants reported that they received the same information through different channels or did not require Live AMS for their role.

Conclusions: Our findings highlight the importance of user engagement to promote uptake of digital health tools. Despite reduced utilisation of Live AMS at one hospital, AMS staff appeared to complete similar AMS tasks successfully. An understanding of workflows and user needs prior to implementation is likely to reveal whether a digital tool will in fact be useful and used.

Peer-support mobile app for adolescent mental health prevention

Louise Birrell — 2023-12-19

Background: While mental health apps and online programs have proliferated, there is a lack of evidence-based online interventions aiming to upskill adolescents around supporting peers in relation to mental health and/or substance use.

Aims: To develop and trial the ‘Mind your Mate’ program, a brief classroom lesson and smartphone app for adolescents (aged 15-16 years) targeting peer support around anxiety, depression, and substance use.

Methods: The program was collaboratively designed by young people and aims to upskill and empower adolescents to better support their peers around mental health and substance use. It is a self-guided program, providing adolescents with normative information about mental health and substance use, facilitating checking in with friends and encouraging help-seeking.

A cluster RCT was run during the first wave of the COVID pandemic. Primary outcomes included substance use and mental health knowledge, use of alcohol and drugs, anxiety and depression symptoms. Outcomes will be analysed using mixed-effects linear regression and mixed-effects logistic regression.

Results: The program is currently being evaluated in 12 Sydney secondary schools, with n=400 student. 12-month follow-up data will be available from June 22 and outcomes results will be presented at the conference. Preliminary analyses demonstrate an app registration rate of 13.5%, a 3-minute average engagement time, and 49 users accessing 1.6 education modules on average.

Conclusions: It is anticipated that compared to the control condition, students who receive the intervention will show delayed uptake of substance use and less mental ill health.

The effect of an active virtual reality gaming intervention on physical activity and mood in young men with mild to moderate depression; a randomised controlled feasibility trial to improve physical and mental wellbeing during Covid-19.

Fiona Hargraves — 2023-12-19

Title: The effect of an active virtual reality gaming intervention on physical activity and mood in young men with mild to moderate depression; a randomised controlled feasibility trial to improve physical and mental wellbeing during Covid-19.

Background: Physical activity is shown to improve depressive symptoms, however, depression is associated with low physical activity participation, as motivation, engagement and adherence are particularly challenging. Virtual reality gaming has great potential to increase engagement and adherence to physical activity in young adult males, a hard-to-reach population with low help-seeking rates but high incidence of mental illnesses.

Aims: Our feasibility trial seeks to address the evidence gap in achieving physical activity behaviour change in young men affected by depression using novel digital technology, to help develop innovative interventions for improving physical and psychological health.

Methods: Participants engaged in an eight-week intervention of physically active virtual reality gaming at home. Heart rate, session duration and frequency were tracked, and outcomes include feasibility (recruitment, motivation, engagement), mood, adherence and lifestyle behaviours.

Results:

Preliminary data analysis showed strong feasibility results; a 23.2% recruitment rate (eligibility out of those who applied), 100% enrolment rate, and a 93.3% retention rate.

There was a statistically significant decrease in depression and stress, and increase in Energy, Role functioning /Emotional scores, physical activity levels and Stage of Change. There was a statistically significant moderate negative correlation between depression scores and both number of gaming sessions >30 mins over the eight weeks and total number of sessions.

Conclusion: This investigation will provide randomised controlled evidence and translational outcomes for feasibility, acceptability, and adherence to inform future research and practice in recommending virtual reality gaming for physical activity and mood in young men affected by depression.

Offering disadvantaged adolescents hope for a better future through eHealth interventions targeting poor diet, alcohol use, tobacco smoking and vaping: Findings from a systematic review

Lyra Egan — 2023-12-19

Introduction: Chronic disease burden disproportionately affects disadvantaged adolescent populations. Preventing chronic disease risk behaviours including poor diet, alcohol use, tobacco smoking and vaping in adolescence is critical. Universal eHealth interventions provide effective prevention, and are a potentially viable option to reach disadvantaged adolescents. However, it is unclear whether they adequately serve disadvantaged adolescents, including those from lower socioeconomic and geographically remote contexts.

Aims: We aimed to synthesise evidence for the effectiveness of eHealth interventions targeting disadvantaged adolescents in preventing poor diet, alcohol use, tobacco smoking and vaping.

Methods: Seven electronic databases were systematically searched. Eligible studies were randomised controlled trials and quasi-experimental trials of eHealth interventions targeting diet, alcohol use, tobacco smoking and vaping among adolescents, that reported at least one marker of socioeconomic status or geographical remoteness. Two reviewers screened, extracted data, and assessed risk of bias.

Results: 3278 articles were identified and fifteen were included for extraction. Nine trials were among adolescents of low socioeconomic status (targeting poor diet [n=6]; alcohol use [n=2], and tobacco smoking [n=1]), four were among adolescents living in geographically remote areas (targeting poor diet [n=3], and alcohol use [n=1]), and one study focused on adolescents of low socioeconomic and geographically remote backgrounds (targeting alcohol and tobacco smoking). No studies targeted vaping.

Conclusions: There is a lack of eHealth interventions targeting adolescents from disadvantaged backgrounds in preventing poor diet, alcohol use, tobacco smoking and vaping. Addressing these risk behaviours among disadvantaged adolescents has the potential to improve future health and narrow health inequities.

How do Australian health authorities use social media to target youth with COVID-19 messages? A content analysis.

Melody Taba — 2023-12-19

Title: How do Australian health authorities use social media to target youth with COVID-19 messages? A content analysis.

Background: The COVID-19 pandemic has highlighted the importance of social media to disseminate health information to the public. Health authorities can harness social media to target messages to priority populations, such as young people, in a timely and accessible way.

Aims: This study investigated the content of COVID-19 social media posts by Australian health authorities targeting young people (16-29 years old).

Methods: COVID-19 posts from all Australian State and Territory health department Facebook, Instagram and Tiktok accounts were extracted over the month of September 2021. Youth-targeted posts were subsequently extracted and their content analysed thematically with metrics subject to descriptive statistics.

Results: In total, 238 youth-targeted posts were identified from 1059 COVID-19 posts extracted. All health departments used Facebook, five used Instagram, and only one used TikTok. The majority of posts implicitly targeted youth; only 14.7% explicitly mentioned age. The COVID-19 ‘outbreak’ states most commonly posted about testing and vaccination (38% and 27% of posts), whilst non-outbreak states concentrated on vaccination (72% of posts). All posts included accompanying visuals; 77% were still images whilst 23% were videos. Engagement strategies were present, but rarely used; only 6% of posts were memes and 16% used humour. Priority groups such as cultural or chronic health and disability groups were rarely targeted in posts.

Conclusions: There is a need for greater health communication explicitly targeting young people on social media to cut through misinformation. Health authorities can leverage popular social media phenomena like memes, humour and virality to effectively deliver public health messages to this target group.

Localisation and usability evaluation of an information diary tool to measure health information access and exposure

Hooi Min Lim — 2023-12-19

Title: Localisation and usability evaluation of an information diary tool to measure health information access and exposure

Background: It is a challenge to connect data about the health information people are exposed to and their health attitudes and behaviours. A digital information diary tool was developed to address this challenge, and we tested its usability when localised for a specific study.

Methods: We used a mixed methods design to evaluate how participants used the information diary and their perspectives of usability. Participants were recruited from a primary care clinic and used the tool for a week. We measured usability with the System Usability Scale (SUS) questionnaire. We explored issues qualitatively via interviews with participants, analysing the data using thematic analysis.

Results: The tool was updated for use in three languages and tested with 24 participants. The mean SUS score was 69.8±12.9. Five themes emerged related to utility: functioning as a health information diary; discussing information diary with their doctor; learning about the credibility of information; being more aware of what they access because of the tool; and comparing their results with others. Four themes related to usability were: ease of use; confusion about selecting information source categories; capturing offline information with photos; and assigning a trust level.

Conclusions: We evaluated the process of localising an information diary tool and discovered challenges related to balancing the requirements of researchers using the tool for data collection and the way users wanted to use the tool. We did not encounter any major challenges with localisation, suggesting the tool could be quickly adapted to local contexts globally.

Co-design of a digital workplace wellness intervention in Malaysia

Jessica Watterson — 2023-12-19

Background: Malaysia is currently experiencing high, and growing, rates of chronic disease. Lifestyle risk factors, such as obesity, lack of physical activity, smoking, and poor diet all contribute to the onset of these conditions and to worse outcomes. Previous studies suggest that workplace wellness initiatives can benefit both individuals and employers (e.g., through lower healthcare costs and reductions in absenteeism).

Aims: This abstract outlines phase one of the study, which aims to co-design a socially-driven digital health intervention to promote healthy behavior in a workplace in Malaysia.

Methods: In this co-design phase, a total of 12 interviews were completed with employees to understand the barriers and facilitators to healthy behaviors in the workplace, including social factors (drawing on social cognitive theory and other social influence theories). Next, co-design workshops were developed, based on the findings from the interviews, and conducted with employees to design workplace wellness activities that fit the company culture and constraints.

Results: The employee interviews uncovered barriers to healthy behaviors, such as limited availability of healthy food options, and facilitators, such as co-workers participating together in activities. Co-design workshops explored how these factors could be leveraged or addressed in the design of wellness activities for the company. While not an initial focus of the study, an additional theme that emerged from both interviews and co-design workshops was the need for more mental health support for employees.

Conclusions: The co-design process uncovered important barriers, facilitators, and ideas while designing a culturally-relevant digital workplace wellness intervention in Malaysia.

Internet-delivered cognitive bias modification: Can this novel digital health program improve anxiety and hazardous drinking among young people?

Katrina Prior — 2023-12-19

Introduction: Up to 60% of young people who receive treatment for alcohol use quickly relapse to heavy drinking, particularly those who drink to alleviate anxiety symptoms. Cognitive Bias Modification (CBM) digital interventions are effective add-on treatments for these disorders individually; however, there is little research on the effectiveness of CBM in treating co-occurring alcohol use problems and anxiety. This presentation will outline the feasibility, acceptability, and preliminary efficacy of an online CBM program for young adults with comorbid anxiety and alcohol use problems (‘Re-Train Your Brain’).

Methods: Australian youth aged 18-30 (n=100) with anxiety and hazardous alcohol use were randomised to receive the 10-session online Re-Train Your Brain CBM intervention plus treatment as usual (TAU) or TAU only. Assessments of anxiety, alcohol use, anxiety interpretation biases, and alcohol approach biases occurred at baseline, 6 weeks and 3 months post-baseline. Feasibility (e.g., adherence, study attrition) and acceptability (e.g., assessed by the System Usability Scale [SUS] and Client Satisfaction Questionnaire [CSQ]) were assessed at the 6-week time-point.

Results: The study was deemed feasible, with high levels of adherence (81% completed at least one training session, with an average of M=5.5 sessions completed) and high follow-up rates (60-75%). SUS scores (M=84.0) indicate the program is “excellent” and associated with a positive user experience, and CSQ scores (M=24.8) indicate moderate to high satisfaction with the intervention. Efficacy analyses are currently underway.

Conclusion: This world-first digital CBM program carries enormous potential to improve outcomes in a complex group that respond poorly to standard treatments.

Translation of findings from a randomised controlled trial to real-world implementation of an online self-help program in an Australian youth mental health service

Sarah Barakat — 2023-12-19

Background: Despite the availability of evidence-based treatments for bulimia nervosa (BN), there exist numerous barriers in being able to these treatments. Developing new cost-effective and accessible delivery mechanisms is essential to ensure early receipt of treatment. This has been further emphasized as a result of the COVID-19 pandemic, which has increased demands for flexible, by-distance treatment options. Binge Eating eTherapy (BEeT) is one of the first online CBT programs for eating disorders in Australia.

Aims: The trial aims to compare the effectiveness of engaging in the BEeT program in a purely independent manner to use of BEeT in conjunction with regular support from a non-specialist clinician (30 min videoconferencing session per week) to waitlist control.

Methods: BEeT consists of ten one-hour interactive, multi-media sessions and includes an inbuilt calendar with self-monitoring tools. This presentation will deliver key findings from a multisite, three-arm randomised controlled trial (RCT) of BEeT involving 114 participants with full or sub-threshold bulimia nervosa.

Results: The trial aimed to compare the effectiveness of pure self-help BEeT vs clinician-supported BEeT vs WLC. Baseline to post-treatment decreases in objective binge episode (OBE) frequency was greater for clinician supported as compared to WLC (d: 0.74, p= .004), however this was not the case for pure self-help (d: 0.40, p = .349). Pure self-help participants did display a further decrease in OBEs at follow up and as a result outperformed WLC when analysed as an overall rate of change across three timepoints of baseline, post-treatment and follow up. This presentation will also provide an overview of our progress in collaborative effort with “headspace”, a nation-wide youth mental health service in Australia, to provide a brief, four-week version of the BEeT intervention to children and young people (12-25 years old) experiencing mild to moderate symptoms of binge-eating or compensatory behaviour.

Conclusions: When considered alongside the largely equal number of participants who no longer met criteria full threshold BN at post-treatment and follow-up, these findings challenge the long-standing assumption held by the field that clinician supported interventions are more effective than pure self-help and suggest a unique benefit of unsupported use.

How Do Online Actors Navigate Facebook In Communicating Vaccination Messages

Damilola Ayeni — 2023-12-19

Background: Factually, health information is important to tackle issues around vaccination. The distribution of false information from online actors about the efficacy of vaccination online and on social media platforms has also been on the rise. This paper examines how various vaccination activists use Facebook to communicate critical messages about vaccination in Australia.

Aims: This paper argues that online actors leverage and negotiate the affordances of Facebook in different ways to communicate vaccination messages. Social media affordances are platform features that enhance, promote, or encourage communication practices and social interactions (Bucher & Helmond, 2017). It is also a relationship between the technology and the users and the possible or actual outcomes from the user's interactions with that platform (Evans, Pearce, Vitak, & Treem, 2017).

Methods: As this paper focuses on vaccination contents produced by online anti-vaccination groups, data was gathered using semi-structured interviews to identify specific techniques and practices used to communicate messages about childhood vaccination in Australia

Results: This paper offers an understanding of the specificity and complexity of communication techniques and practices of online actors on Facebook and how that influences the understanding of vaccination in Australia.

Conclusions: Findings from this paper significantly show an understanding of the evolving nature of social media platforms. Additionally, understanding online users' communication techniques, practices, and communities have uncovered some novel strategies for navigating Facebook.

Cyberscams and Acquired Brain Injury: Developing a measure to assess online risk and safety for people with ABI.

Jao Carminati — 2023-12-19

Title: Cyberscams and Acquired Brain Injury: Developing a measure to assess online risk and safety for people with ABI.

Background: Individuals with acquired brain injury (ABI) may be vulnerable to cyberscams due to cognitive and social changes post-injury. However, lack of existing measures regarding online risk for people with ABI limits our ability to objectively investigate ABI-specific risk factors to cyberscams, assess the frequency of this problem, and evaluate evidence-based interventions. The CyberAbility Scale was developed to assess vulnerability for people with ABI via self-rated statements and a practical scam identification activity.

Aims: This study aimed to develop and refine The CyberAbility Scale through feedback from ABI clinicians and people with ABI. This forms part of a larger ongoing scale development project.

Methods: Scale feedback was collected via three rounds of feedback with ABI clinicians (n=14) using Delphi methods, and two rounds of feedback with participants with ABI (n=8) who participated in a cognitive interview. Following each round, feedback was summarised and revisions were made accordingly.

Results: Key revisions from clinician feedback included removing a total of 12 items deemed clinically irrelevant. Instructions and rating scales were revised to improve clarity. Cognitive interviews identified 15 comprehension errors, and further revisions were made to support recall and response difficulties for participants with ABI. Overall, clinician and ABI participants supported the content and face validity of The CyberAbility Scale. Initial psychometric evaluation will also be discussed.

Conclusions: The CyberAbility Scale has the potential to be an effective screening measure of online vulnerability for persons with ABI with utility within clinical and research settings. Further validation work is currently underway.

Not useful or difficult to use? Clinicians’ grievances against drug-drug interaction alerts.

Kristian Stanceski — 2023-12-19

Background: Medications that are harmful when concurrently prescribed contribute to adverse drug events in hospitalised patients. Drug-drug interaction (DDI) alerts are designed to notify prescribers of potentially harmful drug combinations, yet are often ignored by prescribing clinicians.

Aims: The aim of this study was to explore prescribers’ perceptions of DDI alerts and to identify key barriers impeding integration of the system into prescriber decision-making.

Methods: Semi-structured interviews were conducted with clinicians from two major Australian hospitals. Questions focussed on how users interact with DDI alerts, as well as aspects of the alerts that hinder clinician integration of the system into prescriber decision-making. Common themes were extracted from interviews by two researchers and subsequently mapped to the relevant determinants in the Technology Acceptance Model-3 (TAM3).

Results: Factors relating to usefulness of the alert system were the most frequently raised barriers to routine use of alerts during prescribing tasks. These included clinicians’ perceptions of the system’s relevance to their role and the degree to which their tasks benefit from having alerts in place. In contrast, perceptions relating to how easy the system was to navigate were less frequently mentioned.

Conclusions: In order to increase the uptake of DDI alerts, they need to be more useful, or perceived to be more useful by prescribers. This can be achieved through demonstrating the utility of alerts to users, as well as improving the objective value that the system provides by, for example, improving the clinical relevance of alerts to individual patients.

Embedding Digital Therapeutics into Primary Care: A New Era of Prescribing and Dispensing

Janet Cheung — 2023-12-19

Aims: To explore primary care HCPs attitudes towards DHIs and perceived readiness for practice integration.

Methods: Secondary analysis of two qualitative datasets collected from HCPs enrolled in a clinical trial evaluating SleepFix, an app-based intervention for insomnia. Interviews were guided by a schedule of questions focusing on HCPs’ current use of DHIs, perceived practice barriers/enablers of implementation, user experience of SleepFix and potential models of care for integrating DHIs into practice. Interviews were transcribed verbatim and thematically analysed.

‘I'm glad my bub has just weaned so I don't have to make that decision!’: Preliminary results from an online social listening study on breastfeeding and COVID-19 information

Becky White — 2023-12-19

Background: The COVID-19 pandemic has dominated global attention since early 2020 and the approval of vaccines was a welcome milestone. The exclusion of breastfeeding and pregnant women from clinical trials meant evidence-based advice for this group lagged and has at times been contradictory and confusing. Breastfeeding is an important public health issue and health professionals were concerned that this confusion could impact poorly on breastfeeding outcomes.

Aim: This study aimed to understand breastfeeding-related COVID-19 information sharing and reactions on social media during the Australian vaccine roll-out.

Methods: The CrowdTangle platform was used to source data. Posts were categorised to both intent and source, and mapped with a timeline of related events and announcements. Descriptive analysis was used to understand data distribution patterns and qualitative analysis is under way.

Results: A total of 945 posts were included for analysis. Interactions per post ranged from 0-6,500. Vaccine-related posts were the highest in number and increased over time. Non-profit organisations shared the highest number of posts (n=241), but interactions per posts were highest from personal accounts. Peaks in posts and interactions mapped to key announcements and pandemic events. Preliminary qualitative analysis shows changes in intent over time with full analysis currently underway.

Measures of socioeconomic advantage are not independent predictors of support for healthcare AI: subgroup analysis of a national Australian survey

Emma Frost — 2023-12-19

Background: Applications of Healthcare Artificial Intelligence (HCAI) have the potential to improve aspects of healthcare. However, studies have shown that HCAI also has the potential to perpetuate existing inequities, performing less effectively for marginalised populations. Studies on public attitudes toward Artificial Intelligence (AI) outside of the healthcare field have shown higher levels of support for AI amongst socioeconomically advantaged groups that are less likely to be sufferers of algorithmic harms.

Aims: We aimed to examine the sociodemographic predictors of support for scenarios related to HCAI.

Methods: The AVA-AI survey was conducted in March 2020 to assess Australians’ attitudes toward artificial intelligence in healthcare. An innovative weighting methodology involved weighting a non-probability web-based panel against results from a shorter omnibus survey distributed to a representative sample of Australians. We used multinomial logistic regression to examine the relationship between support for AI and a suite of sociodemographic variables in various healthcare scenarios.

Results: Where support for AI was predicted by measures of socioeconomic advantage such as education, household income, and SEIFA index, the same variables were not predictors of support for the HCAI scenarios presented. Variables associated with support for HCAI across all three scenarios included being male, having computer science or programming experience, and being aged between 18 and 34 years. Other Australian studies suggest that this group have a higher level of perceived familiarity with AI

Conclusions: Our findings suggest that while support for AI in general is predicted by indicators of social advantage, these same indicators do not predict support for HCAI.

The SAGE yoga trial: Online delivery during COVID19

Giane Camara — 2023-12-19

Background: Challenging balance can prevent falls. Yoga practice can be a source for it, although the effect of yoga on falls has not been evaluated.

Aims: The NHMRC-funded Successful AGEing (SAGE) yoga trial aims to establish the effect of two distinct yoga exercise programs on falls rate of community-dwelling people aged 60 years+. This presentation outlines the key learnings from transitioning to online classes once the COVID19 pandemic interrupted face-to-face interactions.

Methods: Participants were randomised to either: (1) the SAGE yoga exercise program, 40 weeks of twice-weekly supervised classes focussed on standing balance-challenging; or (2) a seated yoga relaxation program, 2 supervised classes followed by unsupervised practice. Primary outcome is the rate of falls in the 12 months post randomisation via self-reported surveys and follow-up phone calls.

Results: 700 participants were recruited from September/2019 to October/2021. Since April/2020 face-to-face classes were delivered online via Zoom. The new classes started after were completely delivered online. The change to online classes expanded recruitment locations and offered people in regional and remote settings the possibility to participate. The public response to this was outstanding, showing that access to supervised online physical activity is indeed valued. Providing technology support, an initial one-on-one online introduction to the yoga instructor and access to class-specific Whatsapp groups to promote social connection, have contributed to the success of the online delivery format.

Conclusions: Considering the impact of COVID19 on our ways of living, further exploration of online fall prevention exercise programs is crucial and can be an inclusive practice to be scaled up.

Acceptability and feasibility of a mobile health intervention to support patients with chronic pain during opioid tapering: a pilot randomised controlled trial

Ali Gholamrezaei — 2023-12-19

Background: Opioids are no longer recommended as long-term therapy for chronic noncancer pain (CNCP). Patients are advised to reduce/discontinue opioids when the risks outweigh the benefits. Patients report difficulties in tapering, necessitating the development of, and access to, supporting interventions.

Aims: To develop and evaluate the acceptability, feasibility, and efficacy of a mobile health intervention to support patients with CNCP during opioid tapering.

Methods: A mobile health intervention, consisting of a psychoeducational video and a library of text messages, was co-produced by patients, clinicians, and researchers and was evaluated by consumers and clinicians panels. After revisions, a pilot randomised controlled trial was conducted to test the acceptability, feasibility, and potential efficacy of the intervention. Patients with CNCP who were tapering opioids were randomised to receive the intervention in addition to the usual care for 4 weeks. Acceptability, feasibility, and potential efficacy were assessed.

Results: To date (12 months into recruitment), 38 patients have been screened, 26 met the eligibility criteria and were randomised. Feedback surveys indicate the acceptability of the intervention (e.g., useful 70%, supportive 80%, recommending to others 90%). Most participants suggested a longer intervention period. Recruitment is still open and potential efficacy data will be presented at the meeting.

Conclusions: It is feasible and acceptable to support patients during opioid tapering with text messaging interventions that are co-designed. Most patients wish for support for longer than 4 weeks, hence, a definitive trial with large sample size (national level) is initiated to test the efficacy of a 12-week intervention.

Measuring the success of a learning health system: development of an evaluation framework for the Sydney Kid’s Learning Health Initiative

Grace Currie — 2023-12-19

Background: Accessibility of electronic patient data should enable more hospitals to become ‘learning health systems’ (LHS).

Aims: We developed an evaluation framework for measuring the success of the Sydney Kid’s Learning Health Initiative, a strategic program at the Sydney Children’s Hospitals Network (SCHN), Australia, which aims to implement a LHS for better use of clinical data and therefore improved patient care.

Methods: We developed a logic model evaluation framework by conducting a series of electronic surveys and a final workshop with a working group of key stakeholders at SCHN. Stakeholders comprised representatives from the program’s operations team, clinicians, executive board, clinical governance, research ethics and governance, consumer involvement and academics in implementation science, and clinical research.

Results: The logic model describes the key inputs, activities, outputs and impacts of the early phase of the program. Key impacts included: 1) children’s health, the number of children reached; 2) social, the number of clinicians trained; 3) economic, the societal costs for improving models of care; and 4) knowledge, changes to local or wider models of care. We will develop several proof-of-concept projects which aim to test our logic model and demonstrate the potential value of implementing a LHS at SCHN. In this presentation, we summarise key considerations for implementing a LHS within an Australian context.

Conclusions: Learning health systems interact with and impact many components across the health system. We have identified several key categories for measuring success of our program that may assist other institutions to develop similar evaluation frameworks.

Sharing care between specialist health services and primary health care using interactive e-care plans

Jane Taggart — 2023-12-19

Background: Public health services are looking for more integrated models of care due to increasing demands of long term care for people with multiple problems across multiple services, limited resources and diverse patient needs.

Currently general practitioners and specialist services develop separate care plans and often patients are unaware of the content of these plans. An interactive shared e-care plan can support the sharing of information and collaboration.

Successful collaboration needs shared goals, knowledge and mutual respect, supported with communication and structural interventions that support health services and general practices.

Aims: Improve communication, collaboration and shared care between health services and primary health care of people with long term conditions using a web-based shared e-care plan.

Methods: Observations and qualitative interviews from a feasibility study for cancer shared follow-up care and implementation of a feasibility study and RCT for people living with severe mental illness.

Results: In cancer follow-up, specialists, patients and GPs were receptive to shared e-care which was enhanced when communication through the care plan was evident. There was variation in patient engagement.

Implementation in mental health has proven more challenging. Processes for care and communication between services is complex and demanding. Resources are limited. Patients are infrequent users of general practice and have multiple GPs.

Conclusions: There are common pathways for implementation of interactive e-care plans in sharing care between specialist health services and GPs. However, solutions are needed to improve relational coordination within and between health services and additional resources to introduce and support these processes.

Broadening the concept of ‘engagement’ in mHealth interventions for equity of access

Victoria Loblay — 2023-12-19

Background: Part of the appeal of digital health solutions and mHealth interventions (mobile/wireless technologies to support health) is their potential to overcome traditional barriers to health information including socio-economic status, region and gender.

Aims: Whilst the ‘digital divide’ has been recognised as a barrier to equity in mHealth interventions, this presentation explores how those without direct access to digital technology can engage with and benefit from mHealth interventions.

Methods: As part of an evaluation of a parenting app to promote socioemotional and cognitive development in early childhood in Indonesia, we conducted qualitative interviews and workshops with a variety of users and stakeholders [parents and caregivers (n=47), local experts on early childhood development (n=6) and funders (n=4)].

Results: ‘Engagement’ with the mHealth intervention did not necessarily involve interaction with the app itself. Many users were informally disseminating app content through non-digital networks in the community. We found engagement and enthusiasm for simple messages derived from the app content (e.g. advice on handwashing) was sometimes more pronounced and impactful through these non-digital dissemination channels. This was particularly evident in rural areas, where mobile phone usage and literacy were low.

Conclusions: Understanding non-digital modes of engagement in relation to mHealth interventions has implications for measuring reach, uptake and impact, particularly in disadvantaged communities and areas with limited access to digital technology. We argue that broadening the concept of ‘engagement’ in mHealth is crucial for realising goals of universal access.

Are nutrition and physical activity chatbots feasible and acceptable to adolescents? A systematic scoping review

Rebecca Raeside — 2023-12-19

Title: Are nutrition and physical activity chatbots feasible and acceptable to adolescents? A systematic scoping review

Background: Improving nutrition and physical activity behaviours depends on access to age-appropriate support. Chatbots – software programs designed to simulate conversations with human users – have the potential to deliver support to adolescents to improve health behaviours, but feasibility and acceptability of chatbots in adolescents is unknown.

Aims: To evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. Secondly, to consult adolescents to identify features of chatbots that are acceptable and feasible.

Methods: Inclusion criteria were (i) participants 10-19 years; (ii) without chronic disease except obesity/type 2 diabetes; (iii) assessed chatbots in nutrition and/or physical activity interventions. Data were presented in a narrative summary. Results were presented to a diverse group of adolescents to identify feasible and acceptable features and gain insights beyond what is published in the literature.

Results: Six electronic databases were searched with five studies included, evaluating five unique chatbots, focusing on nutrition (n=2), physical activity (n=2) and both (n=1). All were supported by mobile applications using a combination of design features (personalised feedback, conversational agents, gamification, monitoring behaviour change). Usage rates were >50% in 3/5 studies. Three studies reported health-related outcomes with one showing promising effects. Adolescent consultation identified novel concerns around chatbot use including ethical concerns and false or misleading information being used.

Conclusions: Limited research is available on chatbots in adolescent nutrition and physical activity interventions, showing low usage rates and insignificant effects. Chatbot design must be reviewed to ensure higher levels of acceptability and feasibility in an adolescent population.

Digital and data literacy for sexual health: a draft framework for policy and practice

Kath Albury — 2023-12-19

Background: The Australian 2018-2022 Sexually Transmitted Infection (STI) Strategy observed that “understanding the social drivers that influence the rates of STI in Australia, such as social media and other technology platforms” was a critical gap in then-current sexual health service provision. Since the Strategy was released, the COVID-19 pandemic has necessitated rapid and urgent adoption of digital technologies within both clinical services and sexual health outreach. Simultaneously, social media, dating apps and associated technologies saw an upsurge of use among everyday users seeking social and sexual connection (Dietzel et al, 2021).

Aims: Digital literacy has been identified within research and practice as a key attribute of health literacy – particularly for health consumers. Similarly, data literacy is emerging as a desirable attribute for both consumers and service providers alike. This paper examines what the terms ‘digital literacy’ and ‘data literacy’ mean in the context of sexual health.

Methods: This paper reflects on qualitative interviews with researchers and practitioners across the fields of public health, media studies, and data studies, exploring the ways digital literacy and data literacy are currently understood (and practiced) within sexual health.

Results: Interviews demonstrated that just as health literacy is increasingly recognized as not simply an individual attribute, but an outcome of systemic or organisational capacity and capability (Sørensen et al, 2021), digital literacy and data literacy are best understood in relation to collective cultures and practices.

Conclusions: We conclude by proposing a preliminary framework for understanding digital and data literacy within sexual health policy and practice.

Who’s Keeping It Real: Social Media Use, Authenticity and Online Self-Expression and the association with Eysenck’s Personality Superfactors

Ash King — 2023-12-19

Background: People frequently utilise social media platforms in order to express themselves online and do so in a way that that is reflective of the real “authentic” self, yet flexible enough to test different aspects of the self. For those who do experiment with different forms of self-expression, individual characteristics such as personality traits have been thought to play an important role. In addition, the nature of content shared appears to also share a relationship with personality and authenticity of online self-expression.

Aims: This study seeks to explore the role of individual characteristics in driving certain approaches to self-expression on social media platforms, specifically through examining how Eysenck’s structure of personality relates to self-expression in the context of social media.

Methods: A total of 489 participants completed a number of online surveys, measuring overall social media use, authenticity of self-presentation on social media (real, ideal, false), self-expression styles (depth, breadth, positivity & authenticity) and Eysenck’s revised short scale personality questionnaire.

Results: Findings demonstrated that extroversion predicts the sharing of one’s authentic self, as well as the sharing of a greater breadth and depth of content on social media. Neuroticism is negatively correlated with sharing an authentic self on SM and with sharing positively-valenced content. Neuroticism positively correlates with the depiction of a false or ideal self on SM.

Conclusions: Overall, the greater authenticity of content shared predicts increased display of SM users’ real self, and a decrease in content intended to impress or portray ones idealised or false self.

Can digital health literacy enable diversification of usability evaluation feedback to optimise universal health interface use – A remotely moderated multi-method feasibility study.

Amanda Adams — 2023-12-19

Background: Providing equitable use of health interfaces is required by all Australians as we transition towards a digital future. Developers undertake usability evaluation to assess designs with representative users although reflecting difficulties diversifying participant samples. An exploration of Digital Health Literacy (DHL) as a mechanism to optimise universal health interface design was undertaken.

Aims: Objectives were 1) To investigate usability feedback by exploring high and low DHL groups suitability when participating in different evaluation methods. 2) To assess if DHL offers developers a strategy to diversify feedback from usability samples to optimise digital health interface design.

Methods: N=28 respondents completed the DHL instrument. Three participants with High-DHL and three with Low-DHL levels were recruited to undertake remotely moderated, multi-method usability protocol. Analysed data explored differences within, and between DHL groups.

Results: Findings suggest stratifying potential participants by DHL can diversify types of usability feedback generated. Overall, participants with High-DHL outperform those with lower DHL when completing tasks. Low-DHL participants experienced: setbacks when initiating tasks, increased interactive complexities, and high cognitive loads increasing likelihood of task failures or abandonments.

Conclusions: Stratifying participants by DHLI was found to be a successful mechanism to diversify usability evaluation feedback generated. Further, this strategy has the potential not only improve the user experience for users who are socially or digitally excluded but also for wider audiences experiencing barriers using of health interfaces

Australian medical regulations and the use of eHealth data analytics to strengthen Continuing Professional Development (CPD). A policy implementation gap analysis with the Australian Specialist Medical Colleges

Carol Pizzuti — 2023-12-19

Title: Australian medical regulations and the use of eHealth data analytics to strengthen Continuing Professional Development (CPD). A policy implementation gap analysis with the Australian Specialist Medical Colleges

Background: Starting from 2023, Australian medical practitioners will have to meet specific mandatory CPD Standards to renew their registration to practice medicine. Among other requirements, they will be asked to undertake “Measuring Outcomes” CPD activities for a set minimum hours per year.

According to the regulatory policies developed by the Medical Board of Australia (MBA), these activities require the analysis of patient health data to be completed and, ideally, the use of large eHealth datasets and big data analytics technologies for better insights.

Australian Specialist Medical Colleges are currently working on the implementation of these particular requirements - even though many of them have voiced their concern around eHealth data accessibility and outcome measurement challenges.

Aims: This study aims to identify the factors that can be addressed by the Colleges to foster data strengthened CPD and to support medical practitioners in completing their mandatory “Measuring Outcomes” activities.

Methods: A policy implementation gap analysis was conducted together with participating Colleges. Specifically, interviews were conducted with those College teams that are responsible of CPD Standards implementation to identify existing barriers and propose a list of recommendations to address them.

Preliminary Results: It appears that pre-existing internal environmental factors - such as organisational operations, structure, and culture - are currently hindering Colleges’ efforts.

Conclusions: Final considerations and related recommendations will be made at study completion.

Parents’ practices and perspectives of accessing health-related information for their young children

Danica Hendry — 2023-12-19

Background: Digital technology (DT) is ubiquitous in the lives of families with young children and a concern for many parents, who find guidelines unrealistic. Research around accessing health-related information frequently focuses on specific health conditions rather than children’s health more broadly, and there is a lack of research surrounding parents of young children’s access to health-related information, including DT use.

Aims: To explore the practices and perspectives of parents of young children accessing health-related information for their children, especially DT use.

Methods: Parents of children aged 0-36 months (n=20, 16 female) completed a sociodemographic survey and participated in an online semi-structured interview on the type of health-related information they seek, from whom and where they seek information, and why they choose these sources. Inductive thematic analysis was completed on the transcribed interview data.

Results: Parents most commonly accessed information about non-urgent health issues. Practices and perspectives were guided by information accessibility, relatability, and trustworthiness, and were impacted by geographical location, number of children and Covid19 restrictions. Online sources were frequently used for sourcing health-related information, specifically government/ organisational websites, and social media. DT use information was less commonly sought, with parents relying on personal values and experiences, and mainstream media messaging, to make decisions about their child’s DT use.

Conclusions: Findings indicate a need for a shift towards broader sources and strategies to allow effective research translation to help inform parents’ perspectives and practices surrounding DT use.

Linked health data: Dealing with demographic data discrepancies

Jacques Raubenheimer — 2023-12-19

Background: Data linkage custodians tolerate error rates of ≤0.5%, which still represent 10,000s of records in large datasets. Demographic variables are important covariates in digital health studies, and discrepancies can influence analysis. It is inadequate to simply discard cases with errors, as errors may not arise from the linkage process, but may be inherent in data prior to linkage, and may thus exceed the error rate. Also, removing cases from multiple datasets compounds the impact.

Aims: Develop an approach to detecting, classifying, and correcting demographic data discrepancies in large linked datasets.

Methods: Using demographic variables sex, birthdate, death date from two data linkage studies (ASHLi and PAVLOVA) as examples, methods are presented for defining within- and between-dataset discrepancies in single-record-per-case and multiple-record-per-case datasets. The difference in dealing with categorical (e.g., sex) and date data is illustrated. Methods are presented for resolving:

- partially missing data

- choosing most common option from a value set

- resolving date boundary errors

- using surrounding date information to resolve date conflicts

Results: Our methods minimise the impact of data errors, retaining a significant proportion of cases (depending on the nature of the variables and the number of variables). A SAS macro which automates the work is presented.

Conclusions: While these strategies are not applicable to all demographic variables, our work shows that researchers can improve the quality of their data without having to discard all discrepant cases. Our automation of these processes will further improve access of these strategies to researchers.

How do health professionals use online communities to engage with their peers?

Rowena Forsyth — 2023-12-19

Background: Online communities have emerged as popular technologies for connecting individuals in health. Research on these communities to date has centred on how these digital health tools support patient to patient peer interactions and professional-patient interactions. Our research instead focuses on how health professionals use online communities (including Facebook, Twitter, Instagram, LinkedIn, WhatsApp) to engage with their peers.

Aims: To investigate how health professionals use online communities for peer education, information exchange, support, and social connection across different online platforms.

Methods: Our study included an international sample of health professionals from medical, nursing, and allied health disciplines including physiotherapy, psychology, speech pathology, and podiatry. Participants completed an online survey that included demographics, engagement and participation in online communities, and instruments including the Social Media in Healthcare Scale and the Physician Well-Being Index. The qualitative interviews centred on experiences, identities and roles in online community participation.

Results: Our participants detailed numerous aspects of their online community participation. This included reports of their use of multiple platforms and distinguishing different ways of presenting themselves and engaging with each platform. Participants described benefits of online community participation as allowing them to communicate with leaders in their fields and developing collaborations that they would otherwise not have access to.

Conclusions: Our initial findings indicate that health professionals use a variety of social media technologies to engage with their peers. They find these technologies to be useful for forming and maintaining peer networks and keeping up with current research in their disciplines.

Digital health startups in the time of the COVID-19 crisis

Imon Chakraborty — 2023-12-19

The digital health industry has focused on designing and developing various technological solutions, such as digital health applications, wireless medical devices, cybersecurity, AI/ML in medical software, robotics assist surgery, logistics, clinicians training, and personalized medicine. Within this industry, the role of digital health startups is rapidly growing. The COVID-19 global pandemic has been a catalyst for the increased use of digital health within healthcare services. The role of digital health startups during the pandemic cannot be understated. This study aimed to fill the gap.

Scopus, IEEE Xplore, and ACM digital library were scanned between 2020 and 2021. The data were also collected from research-based business magazines (Harvard Business Review, MIT Sloan Management Review, etc.). In addition, 25 digital health startup founders were interviewed. An inductive approach was used to analyze the data using Braun and Clarke’s thematic analysis approach.

Out of 795 identified articles, eighteen studies were relevant to the topic. Startups’ stakeholders (entrepreneurs, providers, regulators, and investors) perspectives have been changed towards digital healthcare in COVID-19. Some startups showed adaptive behavior, strategic development, and established million-dollar businesses, while some exhibited malfunctions and had to shut their services. Four themes have emerged from the triangulation of the data- market orientation approach, developing dynamic capabilities, bringing competitive advantage, and improving business performance.

Digital health startups altered their ways of survival and serving during the COVID-19 crisis. Understanding the new norm in business transformation aids startups in implementing digital health services successfully.

The InsideOut eClinic: the development and public release of a self-led, self-signup eTherapy platform for eating disorders

Daniel Rogers — 2023-12-19

Digitally delivered guided self-help programs for eating disorders can reduce treatment barriers
like cost, stigma, geography, and availability of clinicians. Digital eating disorder treatments also
provide a unique opportunity for innovative enhancements such as self-monitoring tools, clinician dashboards, clinician pairing/monitoring and supported self-help options.

Binge Eating eTherapy (BEeT) was one of the first online CBT programs for eating disorders in
Australia. Clinical trials of ‘BEeT’ and a re-formatted four-week version of ‘Brief BEeT’ showed
promising baseline to post-treatment decreases in objective binge eating frequency. After
developing and evaluating these programs, InsideOut Institute has built an eating disorder digital therapy treatment platform (‘the InsideOut eClinic’), which allows us to deliver eTherapies and self-monitoring.

The InsideOut eClinic enables the authoring and delivery of new eTherapies without further digital development. The self-monitoring capabilities allow for food, thought, and behaviour monitoring, goal setting, and Cognitive Behavioural Therapy tools such as exposure and thought challenges, also available as a mobile application. The platform allows for further innovative therapeutic options including the connection of users to clinicians, clinical monitoring or support and patient led or guided experiences.

This presentation will explore the conversion of digital tools from research studies into
operationalised, publicly available treatments, the building of a sustainable and considered
platform that survives outside a particular grant or study, and the use of codesign and research
learnings to inform continuous improvement valuing lived and living experience voices.

VCCC Data Driven Research Hub: a primary care focused linked data resource for health services research in Victoria, Australia

Alex Lee — 2023-12-19

Background: Linked data resources are becoming increasingly important for cancer services research since patients interact with the health system using many different health services, each with their own data collections. Here we introduce the VCCC Data Driven Research Hub (DDRH), a linked data resource incorporating primary care, hospital and cancer registry data from Victoria. Primary care is the first point of contact for many patients’ interactions with the health system so such a resource fills an important gap in clinical data science research infrastructure.

Aims: To provide researchers with an understanding of the DDRH and describe the data sources that it incorporated and how they correspond to patients’ journey of care.

Methods: Descriptive analysis on eight different linked data sources, describing some main features of the data, including data quality and representativeness, as well as characteristics of patient cohorts.

Results: To the best of our knowledge this is the largest linked primary care data resource in Australia. With over 3 million patients included and covering 20 years of data, as well as unified governance and ethics processes, we believe this will be a useful resource for researchers and analysts interested in understanding Victorian patients’ utilisation of health services.

Conclusions: Similar linked data resources exist in other jurisdictions and we demonstrate the value of such a resource in Australia. Projects making use of this data are underway including in the study of: diagnostic intervals; primary care blood tests; and end of life care.

Acceptability and feasibility of CIRCUS: An online Cognitive Behaviour Therapy intervention for multiple health behaviours in women

Sally Hunt — 2023-12-19

Background: Australian women have experienced increased stress recently due to competing roles that women fulfill, exacerbated by the COVID-19 pandemic. Women who experience higher stress levels are more likely to engage in sub-optimal health behaviours. By providing support to manage stress, low mood, and the realities facing women, we aim to reduce reliance on unhelpful coping strategies such as alcohol use, sedentary behaviour, and poor nutrition. eHealth is an ideal platform for deploying such support as it overcomes the structural, geographical and social barriers to accessing health care. CIRCUS is a 7-module eHealth intervention developed in consultation with Australian women and has been tailored to their needs.

Aims: This study evaluates the acceptability and feasibility of the CIRCUS intervention for use by Australian women.

Methods: Women aged over 18-years completed an online baseline assessment of multiple health behaviours and then trialled CIRCUS for 3-weeks. Participants provided feedback on elements of the intervention content, design and presentation at a 3-week follow-up. Website analytics also recorded number of visits to the CIRCUS site.

Results: 190 women consented to the study with 73 completing the baseline assessment and 44 accessing the CIRCUS intervention online. 15 completed the 3-week follow-up assessment. Satisfaction and usage data will be reported.

Conclusions: The majority of those who accessed CIRCUS were satisfied with its content and format, however, the low transition of participants from baseline assessment to use of the intervention and to follow-up suggest modifications to the methodology are necessary.

High digital literacy in Patients Requesting Radiological Studies

Lizzie De Silva — 2023-12-19

Background: Easy internet access to health information has significantly changed how people obtain health-related information. Patients are increasingly taking an active role as health consumers. We studied patients who request referrals from their doctors for radiology examinations. Such patient-initiated referral requests have been recognised as a disruptor to the traditional healthcare model.

Aims: This study aimed to understand individuals who sought online health information (OHI) and to explore the relationship between accessing OHI, and patients securing their requests for radiological referrals from doctors.

Methods: Individuals who had had a radiological procedure in the past five years were invited to complete a 20-minute, anonymous online survey exploring the aims. Included in the survey was a validated digital health literacy measurement scale, eHEALS.

Results: Individuals who scored higher on the eHEALS measure were most likely to request radiological referrals. These individuals were under 55 years old and unconcerned about the credibility of the OHI they sourced. However, notably, most participants with higher scores, secured the desired outcome from their radiological requests.

Conclusions: Increasing digital health literacy due to the availability of OHI, enables patients to be consumers of health through requests for radiological imaging and radiological interventions from their doctors. Those participating, and particularly the higher eHEALS scorers, were comfortable and confident in making their requests and reported obtaining the anticipated outcome from their requested studies. As such, doctors are operating under a new paradigm of healthcare, with the availability of OHI disrupting traditionally fashioned model of care.

User experiences of a remote monitoring program during COVID-19

Andrea Torres Robles — 2023-12-19

Background: Virtual care has gained traction during COVID-19 as it allows patients to be remotely monitored while reducing the risk of infection for patients and healthcare professionals. RPA Virtual Hospital (rpavirtual), launched in February 2020, was the first service in NSW to introduce remote monitoring and follow-up for stable COVID-19 patients in quarantine or isolating at home. Patients received a pulse oximeter (PO) to monitor their oxygen saturation levels, critical to identifying signs of health deterioration. Although preliminary patient experience data have been collected, user perceptions of the intervention have not been fully explored.

Aims: Explore the utilisation, performance and acceptability of the PO by patients and clinicians in COVID-19 remote monitoring.

Methods: Semi-structured interviews were conducted with patients ≥18, monitored by rpavirtual with PO, and rpavirtual clinicians who monitored those patients. Interviews were coded using the Theoretical Framework of Acceptability.

Results: Twenty-one patients and 15 clinicians completed the interview. All participants described the key benefits of the PO as allowing patients to be monitored at home and detection of early deterioration. All participants had a good understanding of the device’s purpose and knowledge about its use and the device was found to be easy to use. However, users also identified factors negatively impacting the accurate use of the PO (e.g. patient age).

Conclusions: The use of the PO for COVID-19 remote monitoring was described as easy and highly acceptable to patients and clinicians. Additional education may be necessary for some patient cohorts.

Chronic pain prevalence, opioid use, and primary care provider prescription patterns

Junlin Lin — 2023-12-19

Background: Opioid medications are one of the most common approaches adopted by primary care providers for chronic pain management but are usually not recommended beyond 3 months. Research studies in chronic pain management at primary care settings remains lacking, and the usual investigations relying majorly on large surveys or questionnaires can lead to bias by missing a large proportion of population.

Aims: Our study aims to provide an overview of chronic pain patients and the primary health care they’ve received using a novel artificial intelligence based machine learning algorithm.

Methods: This study used observational U.S. Medicaid claims data (n>7 million) among 6 geographically different states to identify chronic pain patients in primary care between January 2017 to December 2019. The performance of 8 different machine learning classification algorithms were evaluated to model the risk factors of chronic pain patients prescribed opioids by primary care providers.

Results: Our study demonstrated a prevalence of 25.9% (average age 33.0±19.7 years, 64.0% female) of chronic pain among Medicaid claimants, and 6.5% (average age 37.5±19.4 years, 67.5% female) were considered as high-impact chronic pain. The top 3 performing algorithms for accuracy were XG Boost (0.814), Random Forest (0.810) and Ada Boost (0.806).

Conclusions: With machine learning algorithms, our study yielded a previously under-recognized vulnerable age group of children and adolescents under 18 years old as one of the major risk factors of having an opioid prescription from a primary care provider.

Health Professionals’ perspectives on Virtual Reality in healthcare

Anna Janssen — 2023-12-19

Background: Research has provided evidence for the effective use of Virtual Reality (VR) for mental health services, pain management, rehabilitation and surgical skills development. Despite the growing interest in VR in healthcare, its implementation as part of routinely delivered care remains a challenge.

Aims: The aim of this study was to understand the barriers and enablers to use of VR in service provision.

Methods: Data was collected via an anonymous online survey between 2019 and 2021. The survey was developed by the researchers to collect data on VR use in health care. It consisted of five demographic questions, twelve structured and Likert style questions and nine open-response questions.

Results: Sixteen health professionals completed the survey. All respondents indicated they had previous experience with VR, but of these only a minority (n=6, 37.50%) indicated that they had used VR in their practice or in the context of health services delivery. The majority of respondents (n=15, 93.75%) felt that VR had value in healthcare. However, respondents identified barriers to using VR in practice including concerns about the time involved using VR in practice (n=7, 43.75%) or setting up the headset (n=6, 37.50%); not having access to organisational infrastructure to use VR (n=10, 62.50%); and not feeling confident using VR in practice (n=7, 43.75%).

Conclusions: Health professionals are interested in using VR to support service delivery, but require infrastructure support and resources to improve their personal confidence for implementing VR with patients.

“I desperately need to know what to do.” Addressing cyberscams in acquired brain injury (ABI): A qualitative exploration of the experiences and approaches of Australian clinicians and service providers.

Kimberly Chew — 2023-12-19

Background: Anyone can be scammed, however, post-injury cognitive and psychosocial consequences experienced by people with ABI may place them at higher risk. Scams result in financial loss and deleterious psychological impacts such as shame and mistrust, and also interfere with neurorehabilitation. Despite these significant consequences, there are no available psychological treatments tailored to cyberscam recovery. Little is also known about how the current workforce is addressing cyberscams in people with ABI.

Aim: To understand the perspectives and needs of ABI clinicians and service providers in addressing cyberscams in people with ABI.

Methods: Qualitative study design. Eighteen Australian multi-disciplinary clinicians and service providers were recruited through purposive sampling. Semi-structured interviews explored current treatments, effectiveness of interventions used and recommendations for future cybersafety recovery interventions.

Results: Reflexive thematic analysis identified eight themes related to scam vulnerabilities and impacts: “Really? I didn’t see that: Executive Difficulties”; “CyberAbility”; “Financial Stress and Independence”; “Not Coping with the Loss of it All”; “Strong Reactions of Trusted Others”; “Scammer Influence”; “Presence/Absence of Trusted Relationship”; and “Nothing Structured To Do”. Each theme directly related to clinical recommendations such as providing psychological and cognitive support, upskilling in financial and cybersafety management, increasing meaningful social engagement, and working collaboratively with families and clinical support teams.

Conclusions: Treatment recommendations specific to each vulnerability and impact highlight the need for a flexible approach towards cyberscam recovery and treatment in people with ABI. These findings will inform intervention development through a planned co-design phase.

Co-designing the user experience of a parenting and early childhood development mHealth app in lower- and middle-income countries

Adam Poulsen — 2023-12-19

Background: The ubiquity of mobile phones globally presents an opportunity to deliver parenting and early childhood development information to promote and optimise the socio-emotional and cognitive development of children during the first five years of life. However, it is crucial to ensure that mobile health (mHealth) solutions appreciate, among other things, cultural and linguistic diversity, especially in lower- and middle-income countries (LMICs). To that end, co-design is one way forward.

Aims: Overall, this work aims to co-create a parenting app “Thrive by Five” to ensure usability, acceptability, and cultural appropriateness in LMICs. Here, findings from nine countries in Asia and Africa relating to the user experience are presented.

Methods: Thematic analysis was applied to co-design workshops conducted with 174 parents and caregivers and 58 in-country subject matter experts from Afghanistan, Indonesia, Namibia, Kenya, Kyrgyzstan, Uzbekistan, The Democratic Republic of the Congo, Cameroon, and Ethiopia. To best inform user experience design, workshop participants were given a walkthrough of the app prototype or a period of hands-on user testing, when possible.

Results: Key feedback on the app user experience indicated several necessary changes, including simplifying and localising language, including short videos, adding more bright colours, illustrations, and animations, and numerous improvements to the app features and functionality.

Conclusions: Using co-design, vital feedback on user experience was elicited to further the ongoing co-creation of a parenting app with and for nine select LMICs.

An AI-powered virtual online platform to enhance clinical genetic service provision

Alison Trainer — 2023-12-19

Background: Escalation in genetic testing is identifying increasing numbers of individuals with high-risk mutations who require life-long, risk-mitigation programs. Adherence to optimal risk-management programs saves lives, empowers life choices and is cost-effective. However, some individuals experience psychological, socio-economic, geographic, and health system-based barriers to care without specialist support. These result in preventable morbidity and mortality and reduce the personal and clinical benefits of testing. Some clinical genetic services (CGS) offer telephone or survey-based follow-up programs, but these are inconsistent, and cost- and time-intensive.

Aims: The goal of this study is to develop the first generation of “GenCare”: an AI-powered virtual online platform functioning as a multidimensional CGS champion to enhance personalised care for patients living with genetic disorders. GenCare will support:

1) Bidirectional responsive communication between the CGS and patients, including collecting and integrating patient data into CGS databases,

2) Incorporate AI-based algorithms that will use these data to automatically assess and identify patients at risk, to optimise and enhance care delivery.

Methods: GenCare is being co-designed and development from experiences and preferences captured through iterative focus groups with all stakeholders. The first stage of eliciting GenCare attributes determined by stakeholders is complete. The paper prototype assessment is underway.

Conclusions: This proposal is currently focussed on individuals with a high familial cancer or cardiac disease risk. GenCare will be a highly scalable digital solution to optimise clinical wellbeing of people living with a high-risk disease predisposition and support CGS to respond quickly to individuals’ needs

Optimising app interface design for an under-served workforce – How co-designing with home careworkers has shaped a resource to support end-of-life care.

Amanda Adams — 2023-12-19

Background: By 2023 more than 275,600 Australians will be supported by home careworkers (HCW) allowing them die in their home. There is, however, a wide range of abilities, knowledge, backgrounds, and experiences among casualised and fragmented home care workforce. Only a third of health careworkers have received formal training in palliative care.

Aims: To collaborate with HCW to create a useable and relevant app for supporting their end-of-life care practice contextualised to their needs, requirements, and abilities.

Methods: A comprehensive co-design process applying user-centred design approach was conducted involving HCW and other home care sector representatives. The design approach included co-design interviews to scope needs of HCW and to identify content/resources. Using card sorting, content concepts were mapped to form an app information. Throughout the development process, evaluations were conducted to assess usability of the app including wireframes and prototypes.

Results: Using co-design interviews with HCW, we developed rich content for an app structured within an evidence-based framework to support end-of-life care. Information architecture structured from card sorting data supported end-user navigation, functionality, language, and information flow. Testing usability and user experience identified errors within the app prototype which were resolved prior to release.

Conclusions: Through a co-design approach, the Home Care app has been adopted by the home care sector as a valuable, usable, and high-quality resource with interaction experiences tailored by HCW to support their end-of-life care practice.

Evaluating single-sample Google Trends research studies: What’s hype and what’s not

Jacques Raubenheimer — 2023-12-19

Background: Digital health studies using Google Trends (GT) have increased exponentially since the release of the first GT paper in 2009. However, the recommendations of two systematic reviews (Nuti et al, 2014; Mavragani et al, 2018) have largely been ignored. Also, only a handful of several thousand studies have used multiple sampling techniques to improve their estimates. The impact of inadequate sampling is unknown.

Aims: To re-examine published studies using multiple sampling from GT and estimate the impact of inadequate sampling.

Methods: We identified four studies with published data: Lazer et al (2014), Gamma et al (2016), Husnayain et al (2019), Schneider et al (2020). We replicated the methods of each study using their own data, confirming their results. We extracted 130 samples of GT data using the same specifications (time, region, terms) as the authors. We repeated the four article analyses on each sample and tallied the impact on the results.

Results: Each study showed some variation in its results across multiple samples, from minor, but noticeable, to significantly different outcomes. As expected, the best estimate was obtained using the mean series across all 130 samples.

Conclusions: Research using GT needs to take multiple samples of data to obtain accurate estimates before analysis. The number of samples needed appear to be related to the time frame (earlier data require more samples). The four studies all used different methods of analysis, and more research is needed to determine the extent to which different analysis methods are impacted by inadequate sampling.

Use it or lose it: The role user unfamiliarity with electronic medication systems plays in medication errors

Madaline Kinlay — 2023-12-19

Background: Electronic medication management systems (EMMS) improve medication safety, but simultaneously introduce new system-related errors, errors highly unlikely with the use of paper records. No research has examined how these errors change over time and whether errors related to user unfamiliarity with EMMS decrease over time.

Aims: To explore how incident reports of system-related errors related to user unfamiliarity with EMMS change over time.

Methods: EMMS-related incidents occurring at three hospitals in a Local Health District between 1 January 2010 and 31 December 2019 were extracted from the NSW Health Incident Information Management System. Each hospital had introduced the EMMS at different time points (one, three and 12 years prior). Factors contributing to these EMMS-related incidents were extracted and classified, including user ‘misunderstanding or unfamiliarity with EMMS or EMMS workflow’ and ‘inadequate training or education’.

Results: The number of incident reports related to user unfamiliarity or inadequate training fluctuated over time but never dissipated. User unfamiliarity and inadequate training were associated with at least 8 incidents every year (range 8 – 55 incidents) and were still contributing factors to reported incidents in the hospital that had had EMMS in place for over 12 years.

Conclusions: EMMS become more embedded in hospitals with long-term use, but our results indicate that user unfamiliarity with the system is an ongoing issue, despite long-term use. This result highlights that EMMS are not set-and-forget systems. Organisations are required to provide ongoing training for new/rotating staff and refresher training with the addition of new functionality to systems.

The Commercialisation Journey for a Mobile Health Application – from mobile pulmonary rehabilitation (m-PR) prototype to Perx-R

Zoe McKeough — 2023-12-19

Background: In 2020, a mobile health platform that provides comprehensive, evidence-based pulmonary rehabilitation called m-PR was developed following collaboration between the University of Sydney, Northern Sydney Local Health District, The Australian eHealth Research Centre (CSIRO), Lung Foundation Australia and the Better Breathing Foundation. This m-PR prototype, co-designed with consumers, has undergone user testing in people with chronic obstructive pulmonary disease (COPD) and it’s effectiveness on clinical outcomes and health economics is currently being evaluated in a RCT. In 2021, a decision was made to partner with Perx Health, an established digital care company, to commercialise m-PR.

Aims: To outline the approach taken from developing and evaluating the m-PR prototype to commercialisation.

Methods: A reflection of a 4 year journey from ideation of m-PR to commercialisation as Perx-R.

Results: Perx Health consists of a daily engagement platform to improve the health of high risk, polychronic patients by promoting medication adherence, exercise programs, text-based health coaching, remote monitoring, education resources, and completion of surveys. The “know-how” in developing m-PR has been merged to the Perx Platform providing COPD specific exercise, education and medication videos, COPD-specific text notifications, and digitalisation of symptom and health status surveys. Perx Health is supporting the Perx-R platform with their in-house product, software engineering and implementation specialists who are dedicated to using their digital industry experience to advance virtual care for respiratory disease in Australia.

Conclusions: Perx-R is now commercially available to provide a comprehensive pulmonary rehabilitation program and support self-management behaviours for people with chronic lung diseases.

Methods used to evaluate clinicians’ acceptance and use of clinical decision support systems over time: a systematic review

Nicki Newton — 2023-12-19

Background: Clinical decision support systems (CDSS) can enhance the safety and quality of patient care, but their benefits are often limited by low acceptance and use by clinicians in practice. While clinicians’ needs may change as they gain experience and familiarity with new systems, limited work has focused on appropriate methods to evaluate early and ongoing acceptance and use of CDSS post implementation.

Aims: To identify and summarise the methods used to capture clinicians’ acceptance and use of CDSS at different time points following implementation in hospital settings and identify gaps to inform future work.

Methods: A systematic review was conducted to identify studies that reported clinicians’ perceptions, attitudes, or interactions with integrated CDSS in live hospital settings. Methods used to evaluate clinicians’ acceptance and use of CDSS, and when they were employed following implementation, were extracted from identified studies.

Results: Of 2966 citations screened, 129 studies met full inclusion criteria. Studies primarily employed quantitative or mixed methods to assess acceptance and use. Qualitative methods were seldom used during the early phases of implementation and few studies captured progression of use over time.

Conclusions: User experiences of CDSS are rarely explored in depth during the early phases of implementation, providing us with limited evidence on user needs at this critical time point. Further work is needed to examine initial acceptance of CDSS and changes in use over time.

Using Incrementalism and Legitimacy to Ensure Ethical Use of Digital Health Data to Provide Accelerated Access to Medicines

Jessica Pace — 2023-12-19

Background: Provisional marketing approval and funding schemes allow medicines to be approved or funded on the basis of earlier data, with post-market data collection—including use of digital health data—to confirm their safety, effectiveness and cost-effectiveness. Ethical and responsible use of digital health data is necessary for both initiatives.

Aims: To explore the beliefs of patients and physicians from Sydney, NSW regarding post-market data collection, including of digital health data, as a component of accelerated access.

Methods: Semi-structured interviews were conducted with 18 Australian physicians and 13 patients and patient advocates; two focus groups were conducted with patients. Both patients and consumers were from medical specialties and disease areas in which accelerated access is most actively discussed. These were transcribed verbatim and analysed thematically.

Results: There was significant diversity in stakeholder opinion. Although all acknowledged potential risks and benefits of increased reliance on post-market collection and use of digital health data, they disagreed on their magnitude and extent and how these should be balanced in both policy formation and clinical practice. Robust data collection, coupled with swift and decisive action by regulators and funders, were seen as necessary to address risks, but not all participants were confident this could be achieved.

Conclusions: Stakeholder analysis shows a range of reasonable views on how to respond to calls for increased reliance on post-market collection and use of digital health data as part of accelerated access. Incremental policy change can maintain the protections of current systems while providing faster access to new medicines where this is needed most. However, not all substantive positions can be accommodated. A focus on fair procedures will increase legitimacy and acceptability of decisions about accelerated access to medicines. I offer a number of practical suggestions to achieve both legitimate and incremental policy making in regards use of post-market collection and use of digital health data in decisions about access to medicines.

social-ABI-lity - using an online training program and a private Facebook group for social media communication practice and peer support after brain injury

Melissa Brunner — 2023-12-19

Title: social-ABI-lity - using an online training program and a private Facebook group for social media communication practice and peer support after brain injury

Background: Social media may offer an important way for people with an acquired brain injury (ABI) to connect meaningfully with others. However, people with an ABI can find it challenging to use social media due to changes in their cognition and communication skills, and rehabilitation clinicians can be concerned about the risks associated with social media use. Furthermore, clinicians have limited resources available to target social media use during rehabilitation.

Aims: To investigate the outcomes of a multicomponent social media communication skills intervention.

Methods: A mixed-methods, pre-post intervention design was used. Participants completed a short, self-guided course about social media skills (social-ABI-lity program), and then participated in a private, moderated Facebook group over a 12-week period (social-ABI-lity Facebook group). Data were collected on social media use and quality of life and participants provided feedback on their experiences via a post-intervention interview. Statistical analysis compared pre-intervention and post-intervention measures and qualitative content analysis was conducted on post-intervention interview data.

Results: 16 participants completed the 12-week intervention. At post-intervention, there were significant improvements in confidence in using Facebook (p = .002) and enjoyment of using Facebook to connect with others (p = .013). Although there was no significant change in reported quality of life, participants reported multiple benefits from the intervention.

Conclusions: This pilot study provided preliminary evidence that this intervention improved outcomes for people with ABI and will inform future intervention development and research to assist people with ABI to build their social media skills for communication and social participation.

Embedded Randomised Control Trial Implementation in the Australian Paediatric Hospital Setting

Alannah Rudkin — 2023-12-19

Background: Embedded trials are randomised trials embedded into electronic medical record (EMR) systems. These trials utilise existing patient data within the EMR. They have high translational value as information routinely collected within the EMR reflects real world, clinically relevant evidence1.They are inexpensive, require no extra data collection, and can facilitate consent using the clinical team. Embedded trials using Epic EMR are being piloted by Murdoch Children’s Research Institute (MCRI) at The Royal Children’s Hospital (RCH).

Aims: The EMR can be used for patient identification, randomisation, treatment allocation, and data extraction. Reviewing the steps taken to implement and optimise these trial procedures ensures embedded trials are an effective, efficient, and realistic option for future investigator researchers.

Methods: The first embedded trial at RCH opened in November 2021. This trial started with a staggered enrolment of patients to identify potential issues with the trial workflow. Any issues and optimisations throughout the implementation of the trial were addressed and logged. A review of the first 20 patient’s data was conducted to ensure completeness and accuracy.

Results: All the Epic EMR prompts performed as expected, however as implementation and recruitment progressed optimisations were identified and actioned. Data for the trial was successfully produced and extracted.

Conclusions: Embedded trials have minimal ongoing costs but require substantial upfront work and expertise to implement. Embedded trials with limited research contact with patients offer an exciting cost-effective and COVID safe trial design. This approach enabled investigators to be able open new RCTs affordably, it also permits monitoring of the trial remotely in real-time.

Headspace Demand Management Strategy: Including lived experience voices to optimise digital solutions in youth mental health

Antonia Ottavio — 2023-12-19

Background:

At Headspace Bondi Junction a surge in referrals followed COVID-19 lockdowns in 2020, causing longer wait times for young people accessing mental health support. In response, a clinical redesign project was initiated.

Key solutions were the implementation of the health technology platform ‘Innowell’ to guide intake and assessment, and a peer worker acting as a digital navigator in young people’s mental health care journeys.

Aims:

· Decrease wait times:

o Intake triage within 2 days compared to 8 days

o Assessment within 2 weeks compared to 8 weeks

o Psychological treatment within 1 month compared to 3 months

· Reduce young people reporting ‘waiting too long’ for psychological treatment from 82% to 30%

· Increase scores on an experience of service survey in domains of participation in care and the impact of care:

o Participation: improve to 95% from 91%

o Impact: improve to 70% from 65%

Methods:

The project adopted a 5-stage implementation methodology with each stage co-designed with young people. Evaluation is mixed-methods, incorporating qualitative interviews with staff, young people and carers.

Results:

Preliminary results demonstrate positive trends:

· Wait times:

o Intake within 4 days

o Assessment within 2.14 weeks

o Psychological treatment within 1.13 months

· 30% of young people reporting ‘waiting too long’

· Experience of service:

o Participation: 89%

o Impact: 68%

Conclusions:

Including lived experience voices in digital youth mental health interventions is vital and impactful. However, refinement is needed to optimise integration of a peer workforce.