Reaching the disadvantaged and disengaged in times of crisis : towards an understanding of information behaviours to inform interventions.

A report on three UK studies seeking to better understand information behaviours in disadvantaged and disengaged circumstances, explore issues of social integration, and inform public library interventions. Heightened access and internalised behavioural barriers are reported beyond those common to the general population, the former influenced by technology and literacy issues, the latter by social structures and norms; barriers consigning many of our subjects to a stratified existence within an impoverished (small) information world. There is evidence suggestive of deception, risk-taking, secrecy, and situational relevance in information behaviours, and a reliance on bonding social capital characteristically exclusive and inward facing. In such circumstances public libraries can provide a key information access and support role, and community role, but there is little evidence of their use. Findings suggest that a rethink is needed in how public libraries meet the information needs of people in disadvantaged and disengaged circumstances. We suggest that a more proactive outreach approach is needed that sensitively addresses issues of trust, confidence and self-efficacy. Action-oriented interdisciplinary research appears warranted to support such activity, which importantly, focuses on influencing information behaviours

Short sleep duration and obesity among Australian children

Extent: 6p.Background: There is limited information on sleep duration and obesity among Australian children. The objective of the study is to cross-sectionally examine the relationship between sleep duration and obesity in Australian children aged 5 to 15 years. Methods: Data were collected using the South Australian Monitoring and Surveillance System between January 2004 and December 2008. Each month a representative random sample of South Australians are selected from the Electronic White Pages with interviews conducted using Computer Assisted Telephone Interviewing (CATI). Within each household, the person who was last to have a birthday was selected for interview. Parents reported the number of hours their children slept each day. Obesity was defined according to the International Obesity Task Force (IOTF) definition based on BMI calculated from reported body weight and height. Results: Overall, parents of 3495 children aged 5-15 years (mean 10.7 years, 50.3% boys) were interviewed. The prevalence of obesity was 7.7% (8.9% in boys, 6.6% in girls). In multivariate analysis after adjusting for sociodemographic variables, intake of fruit and vegetables, physical activity and inactivity, the odds ratio (OR) for obesity comparing sleeping <9 hours with ≥10 hours was 2.23 (95% CI 1.04-4.76) among boys, 1.70(0.78-3.73) among girls, and 1.97(1.15-3.38) in both genders. The association between short sleep (<9 hours) and obesity was stronger in the younger age group. No significant association between short sleep and obesity was found among children aged 13-15. There was also an additive interaction between short sleep and low level of physical activity. Conclusion: Short sleep duration is associated with increased obesity in children especially among younger age groups and boys.Zumin Shi, Anne W Taylor, Tiffany K Gill, Jane Tuckerman, Robert Adams and James Marti

Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children : EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

Introduction: Children with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to design non-coercive ‘nudge’ interventions to encourage positive health behaviours. Our study aims to evaluate the impact of multicomponent nudge interventions on the uptake of COVID-19 and influenza vaccines in medically at-risk children. Methods and analyses: Two separate randomised controlled trials (RCTs), each with 1038 children, will enrol a total of approximately 2076 children with chronic medical conditions who are attending tertiary hospitals in South Australia, Western Australia and Victoria. Participants will be randomly assigned (1:1) to the standard care or intervention group. The nudge intervention in each RCT will consist of three text message reminders with four behavioural nudges including (1) social norm messages, (2) different messengers through links to short educational videos from a paediatrician, medically at-risk child and parent and nurse, (3) a pledge to have their child or themselves vaccinated and (4) information salience through links to the current guidelines and vaccine safety information. The primary outcome is the proportion of medically at-risk children who receive at least one dose of vaccine within 3 months of randomisation. Logistic regression analysis will be performed to determine the effect of the intervention on the probability of vaccination uptake. Ethics and dissemination: The protocol and study documents have been reviewed and approved by the Women’s and Children’s Health Network Human Research Ethics Committee (HREC/22/WCHN/2022/00082). The results will be published via peer-reviewed journals and presented at scientific meetings and public forums. Trial registration number: NCT05613751

Influenza vaccination in children with special risk medical conditions

A considerable number of Australian children are at increased risk of disease or complications from influenza due to a medical condition. Focusing on the health of these children is a public health priority. Vaccination against influenza has been recommended in Australia for people with special risk medical conditions (SRMC) since 1991 (funded 2010). Despite this, vaccination coverage has not been routinely or uniformly measured. The primary aim of this thesis was to identify barriers to coverage in children identified at increased risk of influenza and translate this into interventions that could address low coverage. This PhD thesis comprises five peer-reviewed published papers and one manuscript that present results from a systematic review and three observational studies. The systematic review assessed the current evidence of disease severity, complications and resource use experienced by children with SRMC who were hospitalised with influenza infection compared to healthy children. The first observational study was conducted with parents of children with a confirmed SRMC and examined confirmed influenza vaccination and reporting to Australian Immunisation Register (AIR). The second observational study used data from the 2016 South Australian Health Monitor survey to examine parental awareness of influenza vaccine recommendations. The third utilised a cross-sectional survey and qualitative interviews with the general practitioners (GP) and paediatric specialists, who were identified by parents as the children’s (from observational study 1) treating doctors. Additionally, an intervention to address barriers identified in this thesis was designed. Compared to healthy peers, children with SRMC hospitalised with influenza infection had higher odds of ICU admission [pooled odds ratio (OR) 1.66 (95% confidence interval (CI): 1.25–2.21)], mechanical ventilation [pooled OR 1.53 (95% CI: 0.93–2.52)], death [pooled OR 1.34 (95% CI: 0.74–2.41)] suspected bacterial pneumonia (crude OR 1.7; 95% CI: 1.1–2.6) and experienced prolonged hospital length of stay [adjusted rate ratio 1.75 (95% CI: 1.44–2.11)]. In children with SRMC (n=410) confirmed influenza vaccine receipt at least once in the last two years was 50%. Characteristics associated with uptake included: receiving a specialist (adjusted OR [aOR] 15.80, CI 6.69–37.29) or GP recommendation (aOR 6.76, CI 2.99–15.29) or annual parental receipt (aOR 11.12, CI 5.36–23.06). Sensitivity of the AIR to reflect a child’s influenza immunisation status was low (32.6%) and 78% of parent reported vaccinations were able to be substantiated by a provider with good (κ = 0.677) to very good agreement (κ = 0.814) for 2014 and 2015 respectively. Overall, 33% of parents in the community were aware that all children (<5 years) were recommended influenza vaccine annually, with this knowledge associated with an awareness of the recommendation for children with a SRMC (aOR 9.72, CI 4.14-22.82), living in a metropolitan area (aOR 2.67, CI 1.15-6.22) and being born in Australia (aOR 3.11, CI 1.12-8.65). Overall 51.9% of parents were aware of the recommendation that children with SRMCs should receive the vaccine annually, with this awareness associated with knowledge of the influenza recommendation for children <5 years (aOR 10.22, CI 4.39-23.77) or not being born in Australia [UK/ Ireland (aOR 7.63, CI 1.86- 31.31). The most influential cue to future receipt was a GP recommendation. Only 38.4% of medical practitioners reported they ‘always’ recommended influenza vaccine and less (19.5%) were very confident in understanding all SRMCs.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 202

Are children with special risk medical conditions receiving influenza vaccination? Validity of parental and provider report, and to a National Immunisation Register

Background: To investigate the validity of parent reported influenza vaccination and provider reporting to the Australian Immunisation Register (AIR) in children with special risk medical conditions (SRMC). Methods: Cross-sectional survey with parents of children with a SRMC aged ≥ 6 months and <18 years attending the Women’s and Children’s Hospital, Adelaide, Australia from September 2015 to February 2016. Children aged <7 years provided data to assess provider-AIR reporting. Influenza vaccination status was ascertained from the child’s parent, immunisation provider and the AIR. Concordance was made using the Kappa index and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Results: 389 and 395 parent-provider influenza vaccination records were available for 2014 and 2015 respectively. 78% of parent reported vaccinations were substantiated by a provider with the kappa indicating good (κ = 0.677) to very good agreement (κ = 0.814) for 2014 and 2015 respectively. Discordance was higher in 2014, largely attributable to parents over reporting vaccination. More fathers over reported compared to mothers (Fisher’s exact = 0.052). There were 241 provider-AIR influenza vaccination records. Sensitivity of the AIR to reflect a child’s influenza immunisation status was low (32.6%). Conclusions: Parental report over estimates confirmed influenza vaccination status and is affected by time and relationship to the child. Only a third of influenza vaccinations were reported to the AIR. Timely accurate data is critical to facilitate vaccination and evaluate program coverage

COVID-19 and changes in the National Immunisation Program: a unique opportunity to optimise the Australian Immunisation Register (AIR)

Jane Tuckerman, Christopher C Blyth, Frank, H Beard, Margie H Danchi

Short sleep duration and obesity among Australian children

Abstract Background There is limited information on sleep duration and obesity among Australian children. The objective of the study is to cross-sectionally examine the relationship between sleep duration and obesity in Australian children aged 5 to 15 years. Methods Data were collected using the South Australian Monitoring and Surveillance System between January 2004 and December 2008. Each month a representative random sample of South Australians are selected from the Electronic White Pages with interviews conducted using Computer Assisted Telephone Interviewing (CATI). Within each household, the person who was last to have a birthday was selected for interview. Parents reported the number of hours their children slept each day. Obesity was defined according to the International Obesity Task Force (IOTF) definition based on BMI calculated from reported body weight and height. Results Overall, parents of 3495 children aged 5-15 years (mean 10.7 years, 50.3% boys) were interviewed. The prevalence of obesity was 7.7% (8.9% in boys, 6.6% in girls). In multivariate analysis after adjusting for sociodemographic variables, intake of fruit and vegetables, physical activity and inactivity, the odds ratio (OR) for obesity comparing sleeping Conclusion Short sleep duration is associated with increased obesity in children especially among younger age groups and boys.</p