Healthcare costs not subsidized by the government and are covered by patients, are known as out-of-pocket healthcare expenditure (OOPHE). In Australia, OOPHE disproportionately impacts Aboriginal households, particularly in rural and remote regions. Currently no patient reported measures (PRM) to assess OOPHE exist, despite being an identified priority in Aboriginal communities. This study developed and psychometrically evaluated (validity and test-retest reliability) of an OOPHE PRM for Aboriginal households in outer regional to remote areas. This Aboriginal led study was governed by an Aboriginal Governance Group, which involved a 4-stage process: (i) identification of community-derived OOPHE themes; (ii) item development and expert judgment quantification; (iii) exploratory factor analysis (EFA) to determine factor structure through pilot testing with Aboriginal participants; and (iv) assessment of reliability and stability through test-retest methods. Stage 1 identified OOPHE themes (i.e. barriers, financial strain), informing development of a 15 item PRM in Stage 2. In Stage 3, 39 Aboriginal participants completed Test 1, with EFA revealing a two-factor model; Factor 1 (8 items, internal consistency = 0.91) and Factor 2 (6 items, internal consistency = 0.85). In Stage 4, 32 participants completed Test 2, with over 60% of items showing substantial to perfect agreement (κ = 0.61-0.87) and scale-level reliability as good to excellent (ICC = 0.75-0.92). Two items performed poorly and were removed, resulting in a final 13-item PRM. The OOPHE PRM demonstrates promising psychometric properties as a culturally grounded measure of OOPHE burden among Aboriginal families, supporting advocacy for equitable policy, funding, and health system reform.

There is a lack of validated tools to assess health literacy responsiveness, defined as the organizational capacity of schools to create accessible and equitable environments that support health literacy development, in school settings internationally. This study, the second phase of a three-part research program, aimed to develop a school-based health literacy assessment tool through a systematic, multi-step development process. Building on a prior scoping review that identified 629 items from existing tools, 210 refined items were presented to 22 international experts via a modified Delphi survey. Experts rated relevance, domain fit, and need for revision. Consensus, derived from qualitative analysis of expert feedback, revealed 47 items as highly important, 119 as potentially relevant, and 44 as unsuitable for schools. Expert feedback informed conceptualization of organizational health literacy in schools. The items reflect practical considerations, cross-national, and multidisciplinary perspectives. Findings highlight strong support for domains such as communication, engagement, and workforce development. The next phase includes pilot testing and validation to support implementation of a tool to promote health literacy among students, teachers, and leaders.

Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women-particularly Indigenous women-whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%-100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.

Tobacco control bans are only as effective as their enforcement, and schools are a critical though often overlooked frontline. School tobacco policies (STPs) frequently fail when staff hesitate to act. This study aimed to measure and explain staff engagement in STP enforcement using a newly developed scale. Staff members (n = 624) from 18 Belgian secondary schools took part in the ADHAirE study. Building on previous qualitative studies, we constructed a 10-item scale to assess staff willingness to enforce the STP. We used exploratory factor analysis (EFA) to identify key attitudinal dimensions underlying the scale and conducted multilevel analyses to assess factors that predict enforcement. Participants scored high on willingness to enforce the rules (2.89, range 1–4). EFA revealed two key attitudinal dimensions, each explaining 20% of the variance: the perception that enforcement is a professional role, which was widely endorsed, and sharedness of rules, for which there was less adherence: only half of the participants felt supported by parents, and 40% believed tobacco control was not a school priority. Notably, enforcement was predicted by the perception that rules are enforced by one’s colleagues and the sense that the rules are justified. Bans are likely to be enforced if they are perceived as part of the staff’s professional role and are shared among the school community. Effective enforcement of school smoking bans requires a shared commitment that integrates school staff, leadership, and parents. The validated scale offers a tool for school principals or health authorities to assess that alignment.

Parks can support physical activity and socializing. While children and adolescents' use of these settings is largely socially driven, little is known about relationships between social factors and park visitation and physical activity. This study examined associations between social interactions in parks and park use behaviour among children and adolescents, respectively. Children (8-12 years, n = 213) and adolescents (13-18 years, n = 210) self-reported accompaniment, frequency of socializing during park visits, frequency of seeing known people in parks, park visitation (frequency, duration), park-based activity, and demographics. Logistic regression models, adjusting for age, sex, dog ownership, and school-level socio-economic status, examined associations of social interactions with park visitation (frequency, duration) and park-based physical activity. Children who socialized in parks most of the time and who visited with family or friends had higher odds of visiting parks ≥ once/week and engaging in physical activity compared to children who rarely socialized and only visited with family. Adolescents who more frequently socialized spent more time at the park, visited the park ≥ once per week, and were more likely to be active compared to those who rarely socialized. Adolescents who visited with family and friends visited parks for longer compared to those who visited alone. Given the link between social interactions and park use, understanding how park design and social activities (e.g. programming) can support social interaction is critical for increasing children and adolescents' park use. Future interventions may benefit from targeting both social and physical park environments. Further research should examine causal associations.

Food insecurity is a growing public health concern in Australia; yet, health promotion programs aimed at creating supportive food environments have received limited attention. This study examined how perceptions of the food environment and perceived diet quality differ by food insecurity status, offering insights to guide Ottawa Charter-aligned health promotion strategies in regional Australia. An online cross-sectional study was conducted among adults residing in the Illawarra/Shoalhaven regions of Australia. Food insecurity was assessed using the 18-item USDA Household Food Security Survey Module (HFSSM). Perceived food environment was measured with 11 Likert-scale questions (1 = strongly agree to 5 = strongly disagree) covering food availability, accessibility, affordability, and advertising. Perceived diet quality was assessed using a single self-rated question (1 = excellent to 5 = poor), alongside reported daily servings of fruits, vegetables, and sugar-sweetened beverages (SSBs). A binary food insecurity variable (food secure HFSSM = 0; food insecure HFSSM ≥1) was used to examine associations using linear regression, adjusting for relevant sociodemographic variables. Of 666 respondents, 38% (n = 255) experienced food insecurity (8% marginal, 19% moderate, 12% severe). Food-insecure respondents reported poorer perceptions of their overall food environment (β = 0.38; 95% CI: 0.25, 0.51), including significantly poorer perceptions of the availability of healthy food, food accessibility, and food affordability. They also reported lower perceived diet quality (β = 0.33; 95% CI: 0.15, 0.50), lower vegetable intake, and higher intake of SSBs. This study is the first to demonstrate that food insecurity is associated with poorer perceptions of the food environment and diet quality in regional Australians, underscoring the need for coordinated and multi-sectoral health promotion programs.

Physical inactivity remains a critical public health concern in the UK, contributing to over one in six deaths and imposing substantial economic costs. Despite strong evidence supporting the effectiveness of physical activity (PA) promotion in healthcare settings, delivery of PA promotion remains inconsistent. This cross-sectional survey, conducted across Scotland and supported by Public Health Scotland, explored the knowledge, attitudes, and training of healthcare professionals (HCPs) across primary and secondary care in relation to PA promotion. Quantitative data were analysed employing descriptive statistics, chi-square tests for categorical variables, and Kruskal-Wallis tests for Likert-scale data to explore differences by care setting and profession. A total of 409 HCPs responded, including a broad range of professions. Primary care professionals reported higher perceived knowledge in PA promotion and personal confidence in meeting PA guidelines than their secondary care colleagues. Physiotherapists and doctors reported the greatest perceived adequacy of training in, and subsequent confidence to deliver PA promotion, while nurses reported the lowest. Across all professions, most participants recognized PA as important for disease prevention (98.8%) and treatment (93.3%), but only 68% felt confident advising patients. The findings identify a disconnect between perceived value of PA and HCPs' preparedness to promote it and highlight the need for standardized, interdisciplinary PA education and the integration of consistent PA messaging across healthcare settings. Targeted educational resources and system-level initiatives could enhance practitioner competence and ensure cohesive delivery of PA promotion within Scottish healthcare.

Ultra-processed food (UPF) production and consumption, associated with chronic disease and environmental degradation, is increasing globally. The UPF concept has gained public attention in recent years and has raised concerns of confusion among the public. This study aimed to explore Reddit-a popular online forum platform-discussions about UPFs to identify the main topics of discussion and how UPFs are discussed. A descriptive constructivist approach to qualitative content analysis was used to analyse threads from the r/ultraprocessedfood subreddit, with over 34 000 subscribers. The 'top' 50 threads from the subreddit (i.e. threads with highest engagement) were collected in January 2025. A coding framework was developed deductively to capture a range of UPF issues, including impacts and causal mechanisms. Two authors coded 50 threads comprised of 2730 comments and posted between 2023 and 2025. The most frequently discussed topic was food [n = 45 (90%) threads, n = 1188 (43.5%) comments], followed by dietary patterns [n = 37 (74%) threads, n = 415 (15.2%) comments], health [n = 43 (86%) threads, n = 404 (14.8%) comments], food system [n = 34 (68%) threads, n = 323 (11.8%) comments], and nutri-biochemical components [n = 34 (68%) threads, n = 322 (11.8%) comments]. The least discussed topic was planetary health [n = 13 (26%) threads, n = 25 (0.9%) comments]. Most comments contained information (n = 2,088, 76.5%) or personal strategies/experiences (n = 901, 33%), with a smaller number containing questions (n = 315, 11.5%) or expressing confusion (n = 15, 0.01%). Reddit users often expressed a love for cooking and anger towards unethical food industry practices and UPF harms. Public health communications may benefit from framing UPF messaging around social justice. This paper includes discussion of disordered eating.

Health professionals play an important role in addressing health literacy and ensuring that health systems and information are easy to understand, access, and navigate. We conducted a scoping review to identify and describe measures and tools that assess health professionals’ health literacy competency related to knowledge, skills, practices, attitudes, self-efficacy, and behavioural intentions. Electronic databases MEDLINE, Embase, CINAHL, PubMed, and Scopus were searched in August 2023 and updated in November 2024. Articles were eligible if they included a measure of health professionals’ knowledge, skills, and competencies related to health literacy. We included quantitative studies conducted in all clinical settings and all study types. Two authors independently screened titles, abstracts, and full text articles. The relevant data were extracted and narratively synthesized. In total, 128 articles were identified. We identified 88 unique measures to assess health professionals’ health literacy competencies, which were applied across a range of health professional contexts. Overall 59% (n = 76) of tools were purpose-built and used only once. The most frequently assessed domain of health literacy competency was performance-based knowledge, assessed by 45 unique measures. Thirty-seven unique measures reported some form of validity and/or reliability testing, however, of these measures only 16% (n = 6) examined construct validity. This review provides a comprehensive overview of existing measures and highlights the need for rigorous and externally valid tools that are more closely aligned with health literacy competency frameworks.

Long-term inter-organizational research-policy collaborations that support research coproduction are uncommon and an overlooked preventive health research impact pathway. This study examines how an Australian research-policy coalition involving approximately 25 research and policy members from the Menzies Institute for Medical Research (Menzies), University of Tasmania and Public Health Services, Tasmanian Government Department of Health has evolved over time. Using a mixed methods approach the study investigates the elements that have been critical for supporting the long-standing nature of the collaboration and identifies translational research impacts. Data sources included coalition documentation (i.e. contract reports, funding agreements), stakeholder interviews (N = 9), and a workshop with informal network mapping (N = 13). Interview transcripts and documents were analysed through thematic and discourse analysis. Network data mapping individual connections between coalition members and between the coalition and other organizations were collated and analysed descriptively. Impacts were categorized using Sibley’s seven effects of research coproduction. Analysis of four tri-annual funding agreements (between 2009 and 2023) revealed discoursal changes in measuring preventive health research planning, outcomes and impacts. A growing focus on relational engagement between researchers and policymakers across research priority areas, collaborative practices and joint capacity building activities to promote coproduction of translational research was evident. Interviews revealed these changes were intentional and while valued, the changes created tensions around the expectations of involvement for some coalition members. System factors undermined some engagement strategies such as co-location. Coalition members had worked together for 5.8 years on average (range 0–35 years) most commonly through information sharing, joint research planning and strategy development. Coalition impacts covered all seven effects of research coproduction. This study highlights the value of a long-term commitment to an inter-organizational research-policy coalition to enhance preventive health knowledge translation into policy and practice. Focusing on building and strengthening relational and systemic approaches to researcher-policymaker engagement, the coalition has evolved to embed research coproduction to enhance research relevance and impact.