The e-health literacy framework: A conceptual framework for characterizing e-health users and their interaction with e-health systems

In current e-health research and development there is a need for a broader understanding of the capabilities and resources required for individuals to use and benefit from e-health services, i.e. their e-health literacy. The aim of
this study was to develop a new conceptualisation of e-health literacy with consideration of the experiences of a wide range of stakeholders and in alignment with current technologies. Concept mapping was used to generate a comprehensive and grounded model of e-health literacy. Concept mapping workshop participants included patients, health professionals and medical informatics experts. Eight workshops, carried out in Denmark and United Kingdom, generated 450 statements, separated into 128 clusters. Through an inductive structured analysis, seven domains were identified: 1. Ability to process information, 2. Engagement in own health, 3. Ability to engage actively with digital services, 4. Feeling safe and in control, 5. Motivation to engage with digital services, 6. Having access to systems that work, and 7. Digital services that suit individual needs. These empirically derived domains form an e-health literacy framework (eHLF) and provide new insights into the user’s ability to understand, access and use e-health technologies. The eHLF offers a framework for evaluating an individual’s or a population’s capacity to understand, use and benefit from technology to promote and maintain their health. Such a framework also provides a potential checklist for the development and improvement of e-health services.

FASD: From isolation to inclusion in Australian schools.

This research investigated pedagogical approaches required for the successful inclusion of children and young people living with Fetal Alcohol Spectrum Disorders. The research applied an Indigenist constructivist qualitative method working with one school community. The development of a National Framework for Achieving Inclusion for Australian Students with FASD demands urgent policy and support for educators to meet the complex learning needs of students with FASD.

Turning tapes into text: issues surrounding the transcription of interviews

Transcription of interview data is a common practice in qualitative health research. However, there has been little discussion of the techniques of transcription and the issues inherent in the use of transcription as a strategy for managing qualitative data in nursing publications. The process of transcription may disclose or obscure certain information. Researchers need to question practices of transcription that have been taken for granted and make transparent the processes used to preserve the integrity of data. This paper first examines research reported in nursing and allied health journals employing interviews for data collection and the attention given to the transcription phase. It then deals with issues of concern regarding the transcription of interviews, and offers suggestions for promoting validity.

Objectively assessing "Walkability" of local communities: using GIS to identify the relevant environmental attributes.

Geographic Information Systems (GIS) may be used to measure objectively, those features of the built environment that may influence walking. Public health research on environmental determinants of physical activity in adults shows that different factors can influence walking for recreation, compared to walking for transport. Most studies have used perceived (self-report) rather than objective measures of potentially relevant environmental attributes. We describe how a previously-developed index of ‘walkability’ was operationalized in an Australian context, using available spatial data.               Attributes believed to be of relevance to walking for transport, that are measurable using GIS, are: Dwelling density (higher-density neighborhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult and time consuming). Connectivity (higher intersection densities provide people with a greater variety of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations). Land use mix (the more varied the land use mix and built form, then the more conducive it is to walk to various destinations). Net retail area (there are more options for destinations where goods and services may be purchased and more local employment opportunities that can be reached by walking). The associations of these attributes with walking behaviors can be  examined separately, or in combination. Such GIS data are very helpful in fundamental studies of the environmental determinants of behavior, and also in applied policy research for cities, regions or local communities, to
address public health and environmental issues.

Unhealthy landscapes: policy recommendations on land use change and infectious disease emergence

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers' objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health ; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research ; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

Nurse practitioner standards project : report to the Australian Nursing & Midwifery Council

The aims of the project have been to conduct research that will inform a description of the core role of the nurse, core competency standards for the nurse and standards for education and program accreditation for nurse preparation leading to regsitration and authorisation.

The epidemiology workforce : are we planning for the future?

Epidemiology has a central role in public health practice, education and research, and is arguably the only discipline unique to public health. A strong perception exists among epidemiologists in Australia that there is a substantial shortage in epidemiological capacity within the health workforce and health research, and that there are few graduates with sufficient high-level epidemiological training to fill the educational and leadership roles that will be essential to building this capacity. It was this concern that led the Australasian Epidemiological Association (AEA)--the peak professional body for epidemiologists in Australia and New Zealand--to convene a working group in 2007 to assess and address these concerns. This article summarises the key training challenges and opportunities discussed within this group, and the larger organisation, with the intention of stimulating greater public debate of these issues.

The Pacific OPIC Project (Obesity Prevention In Communities) : action plans and interventions

Background: The Pacific OPIC Project (Obesity Prevention In Communities) includes whole-of-community intervention programs in four countries (Fiji, Tonga, New Zealand, Australia) aimed at reducing the prevalence of overweight and  obesity in youth.

Development of Action Plans: At each intervention site, preliminary interviews  were conducted with youth to identify the potential socio-cultural barriers and  facilitators to healthy eating and regular physical activity in order to attain and sustain a healthy body size. This and other information was presented at a 2-day workshop with community stakeholders, including youth. The participants then prioritised the components for a draft action plan which was later consolidated through further community consultation.

Action Plan objectives: Each action plan had two overall aims: to build  community capacity and to promote healthy weight. The first three objectives in each action plan were on capacity building, social marketing messages, and evaluation. Next were a set of four to five behavioural objectives with associated strategies involving programs, events, social marketing and environmental  change. Lastly, each site had one or two innovative or developmental objectives.

Progress: Interventions began in all sites from 2005, with the action plans guiding implementation priorities. The initial behavioural objective for targeting in Fiji was eating regular breakfast and meals throughout the day, for Tonga it was physical activity, and for Australia and New Zealand it was increasing water consumption and decreasing consumption of sweet drinks.

Conclusions: The action plans have provided the basis for community engagement in the project, the guide to the implementation of activities and the template for the evaluation plan.

The Pacific OPIC project (Obesity Prevention in Communities) - objectives and designs

Background: Evidence on how to reduce the increasing prevalence of youth obesity is urgently needed in many countries.The Pacific OPIC Project (Obesity Prevention In Communities) is a series of linked studies in four countries (Fiji, Tonga, New Zealand, Australia) which is designed to address this important problem.
Objectives: The studies aim to: 1) determine the overall impact of comprehensive, community-based intervention programs on overweight/obesity prevalence in youth; 2) assess the feasibility of the specific intervention components and their impacts on eating and physical activity patterns; 3) understand the socio-cultural factors that promote obesity and how they can be infl uenced; 4) identify the effects of food-related policies in Fiji and Tonga and how they might be changed; 5) estimate the overall burden of childhood obesity (including loss of quality of life); 6) estimate the costs (and cost-effectiveness) of the intervention programs, and; 7) increase the capacity for obesity prevention research and action in Pacific populations.
Design: The community studies use quasi-experimental designs with impact and outcome assessments being measured in over 14,000 youth across the intervention and control communities in the four sites. The multi-strategy, multi-setting interventions will run for 3 years before fi nal follow up data are collected in 2008. The interventions are being informed by socio-cultural studies that will determine the family and societal infl uences on food intake, physical activity and body size perception.
Progress and conclusions: Baseline studies have been completed and interventions are underway. Despite the many challenges in implementing and evaluating community-based interventions, especially in the Pacifi c, the OPIC Project will provide rich evidence about what works and what does not work for obesity prevention in youth from European and Pacific backgrounds.