To explore healthcare workers' perceptions of the response to a hospital-based COVID-19 outbreak early in the pandemic, to inform preparedness for future responses. Qualitative cohort survey. Four months post-outbreak, 252 healthcare workers responded to one or more open-ended questions regarding their perceptions of the response. Five broad themes were identified through qualitative content analysis: (1) communication in a context of uncertainty and rapid change; (2) infection control practices, including availability, adequacy and access to personal protective equipment; (3) staff dedication and mutual support in extraordinary circumstances; (4) appropriateness of outbreak response; and (5) staff vulnerability. An additional two issues cut across these themes: a sense of variability between clinical areas, organisations and work groups in relation to communication and approach to infection prevention and control practices; and an acknowledgement that the response to the outbreak was constrained by assumptions that reflected the state of understanding of SARS-CoV-2 transmission and outbreak management at that time. Healthcare workers who experienced an early hospital-centred COVID-19 outbreak in regional Tasmania, Australia, highlighted the need for enhanced preparedness in terms of infection control training and personal protective equipment availability, adequacy and access for future outbreaks. Planning for a successful future pandemic response also should include emergency communication preparedness, planning for effective communication in a multi-institutional healthcare campus in a situation of constant uncertainty. Staff resilience and commitment should be celebrated and reinforced as assets for future responses, while ensuring recommendations for changes to planning and practice stemming from the outbreak are implemented.

Timely, accurate reporting of pregnancy vaccination coverage is key to evaluating pregnancy immunisation programs. We compared influenza and pertussis vaccination reporting on the New South Wales (NSW) Perinatal Data Collection (PDC) and the Australian Immunisation Register (AIR) to understand coverage, reporting, timing of vaccination and provider type. This retrospective population-based cohort study in NSW, Australia, included people giving birth at ≥20 weeks gestation (2017-2022) on the NSW PDC (total number of pregnancies 555,553), linked to AIR-reported influenza and pertussis vaccinations. The main outcomes of interest were influenza and pertussis coverage according to: (1) the PDC; and (2) linked AIR records. We assessed agreement between data sources (i.e. whether an AIR record during the pregnancy existed if vaccine receipt was reported on the PDC, and vice versa) by year (influenza: 2021-2022, pertussis: 2017-2022) and selected characteristics (2022). Provider type and timing for vaccinations reported to the AIR are described (2022). PDC-reported influenza and pertussis coverage peaked in 2020 (influenza: 58.8%, pertussis: 79.0%), decreasing thereafter (influenza: 49.1%, pertussis: 77.6% in 2022). AIR-reported influenza and pertussis vaccination coverage increased (influenza: 34.7% in 2021 to 44.8% in 2022; pertussis: 24.4% in 2017 to 51.6% in 2022). Agreement between the AIR and PDC improved over time but remained suboptimal (influenza: 75.5%, pertussis: 56.6% in 2022). AIR and PDC agreement differed most by antenatal care model, particularly for pertussis vaccinations. In 2022, of pregnancy vaccinations reported to the AIR, >75% were provided in general practices. Co-administration occurred infrequently (8.8%). Despite mandated reporting to the AIR, there was significant underreporting of pregnancy vaccinations to the AIR when compared with the NSW PDC. National collection of accurate and timely data on pregnancy vaccination coverage is needed to monitor vaccine uptake, and identify and monitor strategies to improve uptake, particularly with the new pregnancy respiratory syncytial virus vaccine program in 2025. We identified co-administration as a potential strategy to improve influenza vaccination coverage during pregnancy.

Ahead of Print article withdrawn by publisher.

To evaluate the effectiveness of training workshops aiming to improve researchers' consumer and community involvement (CCI)-related awareness, attitudes and behaviours, and capture remaining barriers to CCI. Cross-sectional questionnaires. Participants consisted of University of Queensland researchers attending a CCI training workshop facilitated by The Kids Institute between 2017 and 2023. Participants were invited to complete two surveys with multiple-choice and open-field items: (i) short-term evaluation immediately following workshop attendance to capture reactions, and (ii) long-term evaluation up to 6years following attendance, including retrospective and current perceptions of confidence, motivation, capability, opportunity and reported behaviours. Survey items mapped to the Kirkpatrick model for training evaluation (reaction, learning, behaviour and results) and the capability, opportunity and motivation model of behaviour change (COM-B). Multiple-choice responses were summarised with descriptive statistics and Chi-squared analysis, whereas open-field responses were mined qualitatively with content analysis. A total of 17 out of 183 and 104 out of 240 individuals completed/partially completed Surveys 1 and 2, respectively. Survey 1 comments captured satisfaction with content and facilitation, and improved learning (Kirkpatrick's 'reaction' and 'learning'). Most Survey 2 participants were satisfied/highly satisfied with the workshop (n=82/101, 81%), and agreed that CCI was relevant (n=88/90, 98%) or valuable (n=86/89, 97%) to their research (COM-B 'motivation'). When completing Survey 2, a minority (n=17/90, 19%) felt they were confident/very confident in implementing CCI before the workshop, which increased significantly post-workshop (n=54/89, 61%; P<0.05). Participants reported moderate to high levels of capability (n=78/83, 94%) and capacity (n = 73/83, 88%) implementing CCI. The proportion of researchers implementing CCI in their research increased from 65% (n=59/91) to 78% (n=71/91) in the months/years post-workshop (P<0.05). Researchers reported consistent CCI throughout the research journey and diverse models of involvement. Participants identified financial and administrative institutional barriers to optimal CCI implementation in research. These results align with all elements of the Kirkpatrick and COM-B models. CCI training improved researchers' CCI-related awareness, confidence and behaviours. However, the remaining barriers to optimal CCI implementation included logistical and institutional barriers, reflecting the opportunity element of COM-B. Thus, although CCI training of researchers is valuable and effective, institutions need to capitalise on these benefits with administrative and financial support.

Multi-phase participatory co-design study. This project was underpinned by consumer engagement principles (respect and equity; trust; empowerment) and followed the Agency for Clinical Innovation's four co-design steps (Engage; Gather; Understand; Improve). The co-design team comprised people with experience in qualitative and survey research, including members of the Sydney Health Literacy Lab's community panel (Co-SHeLL). The project involved a series of online workshops to discuss each research method and learn from lived experience. Insights from the workshops informed drafts of the guides, which were iteratively revised with ongoing feedback. Health literacy resources including the Health Literacy Editor (assessing grade reading score, complex language, and passive voice) and the Patient Education Materials Assessment Tool (assessing understandability and actionability) were then applied to assess each guide. The two guides provide foundational knowledge about each research method, such as what research questions qualitative and survey research can answer, the types of data collected, and the types of analyses undertaken. Content provides clear examples of how consumers can be involved at each stage of the research process and best practice activities. The guides incorporate health literacy strategies where possible (Grade 9 reading level; 84% understandability and 83% actionability). Through an iterative co-design process, we have developed research guides that seek to build consumers' capacity to engage more deeply in any given project, throughout the research process. They are positioned to support more equitable consumer engagement that better reflects the diversity of the communities we serve including those with diverse health literacy needs.

The aim of this study was to explore experiences of general practitioners (GPs) when referring patients with positive bowel cancer screening tests for colonoscopy, and identify enablers of and barriers to increasing referrals to public nurse-led Direct Access Colonoscopy (DAC) services in New South Wales, Australia. A mixed-methods study was undertaken, with the design, analysis and interpretation informed by implementation science frameworks (COM-B and Theoretical Domains Framework). The quantitative component included an online survey of GPs in July 2024, recruited through primary health care networks. Survey participants could opt in for a follow-up semi-structured online interview. Descriptive statistics were produced with the quantitative data, categorised by general practice setting and size. Qualitative data were analysed deductively using theoretical frameworks. A total of 71 GPs completed the survey, and 18 of those participated in an interview. Ninety per cent of survey participants were located in an area with a DAC service, but only 56% of these GPs were aware of the service (n=51). All but two of the GPs who were aware of DAC had referred a patient to DAC in the previous 12months (n=34, 48%). The top three considerations for GPs when referring patients for a colonoscopy following a positive screening test were: average wait time for the procedure, patient finances and/or insurance, and patient and/or service location. Key factors influencing referral practices were knowledge gaps, unclear eligibility criteria, and lack of systemic prompts for referral. Although DAC was valued for providing timely, cost-free access to colonoscopy, some GPs preferred private referrals because these were more timely and less burdensome for patients. GPs expressed concerns about specialist oversight and continuity of care, which led some to view DAC as an inferior referral pathway. To improve DAC services and strengthen trust in referring to DAC, GPs suggested increased communications about DAC to primary care; clear referral criteria, transparent wait times and simplified referral tools; statewide DAC service provision; clarification of specialist oversight and follow-up of high-risk patients; and targeted messaging about the DAC pathway using peer persuasion through professional networks.

The COVID-19 pandemic brought epidemiology into public focus globally. Understanding patterns and determinants of disease spread was central to risk assessment and the modelling of drivers of transmission to forecast outcomes under different intervention scenarios. Epidemiological analytics, including the reproduction number, were being discussed by the media and the public in ways epidemiologists and biostatisticians could not have foreseen. Yet the statistics being reported were largely confined to two ends of the evidence spectrum - at one end, raw case counts, hospitalisations and deaths, and at the other, sophisticated statistical modelling based on disease dynamics averaged at the whole-of-population level. Other core epidemiological analytic methods that add a more nuanced understanding of variation in disease transmission within and across populations, and risk of infection, were underrepresented. In Australia, for example, the purposeful collection of data to estimate subpopulation-specific case rates, generate relative risks across subpopulations and allow meaningful interpretation within and across populations was limited. This also hampered the real-world evaluation of specific health interventions, including vaccination, and the generation of updated population-specific estimates for statistical model parameters. This was a global phenomenon, though some countries did better than others. What was fundamentally missing was a clear investment in, and coordinated approach to, the quality of surveillance data needed for (a) tracking disease transmission and the degree of control achieved, both of which changed over time, and (b) public communication. The independent inquiry into the Australian Government's COVID-19 Response had evidence generation as a central theme, and investment in evidence synthesis capability and data sharing as clear recommendations for the way forward. The importance of evidence was also raised in discussions informing the draft global Pandemic Agreement. This remains a worrying gap in pandemic readiness, including in well-resourced countries such as Australia where the nuance in public health policy was constrained by the reliance on basic descriptive epidemiology, urban-focused population-level modelling and data insights imported from other countries.

Objective After-action reviews (AARs) are used to systematically examine the functions, capabilities and barriers impacting effective pandemic responses. This paper describes the methods used for and the lessons learnt from undertaking the first formal state-wide AAR of the public health response to COVID-19 in New South Wales (NSW), Australia. Type of program A state-wide AAR was applied to examine the public health response to COVID-19 conducted by Health from January 2020 until May 2022. Methods The AAR was conducted between March and November 2022. The World Health Organization ARR approach was used and involved six stages including: (1) AAR design, (2) AAR planning, (3) team debriefs, (4) workshop preparation, (5) consensus workshop and (6) AAR report review and finalisation. Results The AAR process involved over 100 people across the NSW network through surveys, team debriefs and workshops. The stepped process used to complete the review, with standardised templates, was found to be acceptable and feasible. The preparatory stage elicited important insights, provided an opportunity for structured reflection and helped identify themes for discussion in the workshop. Feedback methods included two participant satisfaction surveys and one post-implementation review session, which identified strengths in the process and areas that could be modified for future iterations of other public health reviews in NSW. Lessons learnt The AAR process successfully engaged multi-disciplinary pandemic response staff in a systematic reflection process. The process was perceived by most participants as a highly valuable opportunity to reflect and it led to important findings to improve public health emergency responses. It is important that the scope of the AAR is well understood by participants and that the psychological needs of the workforce are considered in the AAR process. There is merit in applying such reviews as standard practice in future public health emergencies.

Objective To quantitatively describe the healthcare needs of a cohort of kindergarten children in a low-socioeconomic rural community to inform school entry health check programs and school-based healthcare services. Study type Medical record review. Methods Data were extracted from the community health electronic medical records of children who started primary school in 2019 at one of the five study schools and who received at least one occasion of service from a nurse-led School-Based Primary Health Care Service for a health or developmental concern. Data extracted included demographics, presenting concerns, challenges to accessing care, service activities, and referrals. Results Of the 140 children enrolled in kindergarten in the sample schools, 84 (60%) had an occasion of service for a health or developmental concern. Of these 84 children, speech and language concerns (43%) were most frequently observed, followed by metabolic/nutrition (26%), behaviour (16%), and vision (16%) concerns. Evidence of challenges to accessing care was identified in 40% of cases. Sixty percent of identified children were referred to another provider. Conclusion The high prevalence of health and developmental concerns and challenges to accessing care found in this study supports the need for school entry health check models that provide ongoing support to families.

Australia's National Lung Cancer Screening Program will commence in July 2025, targeted at individuals aged 50-70 years with a 30 pack-year smoking history (equivalent to 20 cigarettes per day for 30 years), who either currently smoke or have quit within the past 10 years. We forecasted the number of screening-eligible individuals over the first 5 years of the program using data from the 2019 National Drug Strategy Household Survey and the 2022 Australian Bureau of Statistics population projections. Multiple imputation integrated with predictive modelling of future or unmeasured smoking characteristics was used to address missing data and, simultaneously, to project individuals' smoking histories to 2030. In 2025, 930 500 (95% prediction interval 852 200-1 019 000) individuals were estimated to be eligible, with the number meeting the criteria declining slightly during the years 2025-2030 in all Australian jurisdictions. Overall, 26-30% of those eligible will have quit smoking, and 70-74% will currently smoke. These estimates can be used in resource planning and as an indicative denominator to track participation rates for the program over time.