[Show abstract][Hide abstract] ABSTRACT: Objectives
The “Mayday Safety Procedure” (MSP) is included in the Australian Rugby Union (ARU) Medical and Safety Recommendations and the mandatory SmartRugby training for coaches. Previous research indicates that translating the MSP into practice among community rugby coaches is challenging. This study investigated whether MSP translation could be enhanced by systematically planning and implementing a range of theory-informed and context-specific diffusion strategies.
A controlled before-and-after study.
Coaches of senior community rugby teams in five zones in New South Wales (Australia) were invited to complete a questionnaire about their MSP knowledge and practice at the end of the 2010 and 2011 rugby seasons. During 2011, coaches in the intervention zone were exposed to a range of strategies to promote MSP diffusion which were planned by following Step 5 of the Intervention Mapping protocol. Coaches in the other four zones were exposed to usual strategies to promote MSP diffusion
Using the RE-AIM evaluation framework, statistically significant improvements were found among intervention zone coaches in: knowledge of most MSP key criteria; the number of coaches recognising their zone policy requiring them to train players in the MSP; frequency of provision of MSP training to players; coach perceptions of the quality of MSP training for players; and in confidence that referees could implement the MSP during a game if required.
The findings suggest that the translation of injury prevention policy into community practice can be enhanced by developing and implementing a theory-informed context-specific diffusion plan, undertaken in partnership with key stakeholders.
Journal of Science and Medicine in Sport. 01/2014;
[Show abstract][Hide abstract] ABSTRACT: Routinely collected hospitalisation data are widely used to monitor injury trends, provide estimates of the burden of injury and healthcare costs, and to inform policy. This study examined the impact of different ICD-10 based case selection criteria commonly used by Australian and international reporting bodies on the number and nature of burn-related hospitalisations identified. METHODS: Burn cases from a state-wide administrative hospitalisation dataset were identified and compared using three different case selection criteria: (1) principal diagnosis code of burn 'T20-T31', (2) first external cause code denoting burn 'X00-X19' and (3) both principal diagnosis code of community acquired injury 'S00-T98' and first external cause code denoting burn 'X00-X19'. RESULTS: Principal diagnosis codes 'T20-T31' and first external cause codes 'X00-X19' identified a similar number of cases, however only 78% of these were captured by both definitions. Principal diagnosis codes identified chemical, electrical and contact burns not identified as burns using external cause codes. First external cause codes identified readmission cases which were not identified by principal diagnosis codes. Using principal diagnosis codes of community acquired injury combined with external cause code of burn under-numerated hospitalisations by forty percent. CONCLUSION: The development, implementation and evaluation of health policy and prevention measures rely on good quality, consistent data. Current methods for identifying burn cases in hospitalisation data provide wide differences in estimation of number and nature of cases. It is important for clinicians to understand the implications of coding on the epidemiology and measurement of the burden of burn.
Burns: journal of the International Society for Burn Injuries 05/2013; · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: This paper describes the development of a theory-informed and evidence-informed, context-specific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia. METHODS: Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation. RESULTS: Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory. CONCLUSIONS: This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher-practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.
British journal of sports medicine 12/2012; · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background This paper describes the development of a theory-informed and evidence-informed, context-specific diffusion plan for the Mayday Safety Procedure (MSP) among community rugby coaches in regional New South Wales, Australia. Methods Step 5 of Intervention Mapping was used to plan strategies to enhance MSP adoption and implementation. Results Coaches were identified as the primary MSP adopters and implementers within a system including administrators, players and referees. A local advisory group was established to ensure context relevance. Performance objectives (eg, attend MSP training for coaches) and determinants of adoption and implementation behaviour (eg, knowledge, beliefs, skills and environment) were identified, informed by Social Cognitive Theory. Adoption and implementation matrices were developed and change-objectives for coaches were identified (eg, skills to deliver MSP training to players). Finally, intervention methods and specific strategies (eg, coach education, social marketing and policy and by-law development) were identified based on advisory group member experience, evidence of effective coach safety behaviour-change interventions and Diffusion of Innovations theory. Conclusions This is the first published example of a systematic approach to plan injury prevention programme diffusion in community sports. The key strengths of this approach were an effective researcher–practitioner partnership; actively engaging local sports administrators; targeting specific behaviour determinants, informed by theory and evidence; and taking context-related practical strengths and constraints into consideration. The major challenges were the time involved in using a systematic diffusion planning approach for the first time; and finding a planning language that was acceptable and meaningful to researchers and practitioners.
British Journal of Sports Medicine 12/2012; · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In 2006, New South Wales (NSW) state legislation changed from requiring smoke alarms in new houses only to all houses. We evaluated the impact of this legislative change on residential fire injury and smoke alarm ownership characteristics. Residential fire injuries for 2002 to 2010 were identified from hospitalization data for all hospitals in NSW. Data relating to smoke alarm ownership and demographic factors were obtained from the NSW Population Health Survey. Negative binomial regression analysis was used to analyze trends over time. Prior to the introduction of universal legislation, hospitalization rates were increasing slightly; however, following the introduction of legislation, hospitalization rates decreased by an estimated 36.2% (95% confidence interval [CI], 16.7-55.8) annually. Smoke alarm ownership increased from 73.3% (95% CI, 72.5-74.2) prelegislation to 93.6% (95% CI, 93.1-94.2) 18 months postlegislation. Thirty percent of households reported testing their alarms regularly. Speaking a language other than English (relative risks [RRs], 1.82; 95% CI, 1.44-2.99), allowing smoking in the home (RR, 1.73; 95% CI, 1.31-2.27), and being part of the most disadvantaged socioeconomic group (RR, 1.47; 95% CI, 1.14-1.91) remain major risk factors for nonownership. Broadening the scope of state legislation has had a positive impact on residential fire-related hospitalizations and smoke alarm ownership. However, it is of concern that the legislation has been the least effective in increasing smoke alarm ownership among non-English-speaking households, in households where smoking is allowed, in low socioeconomic households, and that a high proportion of householders do not test their smoke alarms regularly. Targeted campaigns are needed to reach these high-risk groups and to ensure that smoke alarms are functional.
Journal of burn care & research: official publication of the American Burn Association 09/2012; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pedestrian and pedal cycle injuries are important causes of child morbidity and mortality. The combination of Bayesian methods and geographical distribution maps may assist public health practitioners to identify communities at high risk of injury.
Data were obtained on all hospitalizations of children from NSW (Australia), for pedestrian and pedal cycle injuries, from 2000-2001 to 2004-2005. Using Bayesian methods, posterior expected rate ratios (as an estimate of smoothed standardized hospitalization ratios for each injury mechanism) were mapped by local government area (LGA) across the state.
There were over 7,000 hospitalizations for pedestrian and pedal cycle injuries. High risk LGAs accounted for more than one third of hospitalized pedestrian and pedal cycle injuries in NSW.
LGAs at high risk for pedestrian injury tended to be urbanized metropolitan areas with a high population density, while high risk LGAs for pedal cycle injury tended to be either in urban regional areas, or on the margin of urbanized metropolitan areas. Geospatial analyses can assist policymakers and practitioners to identify high risk communities for which public health interventions can be prioritized.
International Journal of Public Health 01/2012; 57(3):467-75. · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate the level of translation of the Australian Rugby Union 'Mayday' safety procedure into practice among community rugby union coaches in New South Wales (Australia).
All registered coaches of senior community rugby union teams in five zones/associations in the north-eastern region of the state were invited to complete a short online questionnaire at the end of the 2010 rugby season. The questionnaire was designed around the five RE-AIM dimensions and assessed: Reach, perceived Effectiveness, Adoption, Implementation and Maintenance of the Mayday procedure.
Seventy (39%) coaches participated. There was a high level of awareness of the Mayday procedure, and most coaches believed it was effective in preventing injuries. The majority reported training their players in the procedure, although training was generally infrequent. Coaches were confident that their own players could implement the procedure appropriately if required to do so, but less confident that other teams or referees could do so. Barriers to providing training included not enough players at training, players not taking training seriously and technical difficulties (eg, verbalisation of instructions for physical tasks).
The findings suggest that the translation of the Mayday 'policy' could be improved by building individual coach, and club or zone organisational capacity by ensuring that coaches have the resources and skills in 'how' to train their players to complement their existing knowledge on 'what' to train them; setting expectations that encourage coaches to provide regular training for players; and regular monitoring of player competency to perform the procedure appropriately.
British journal of sports medicine 12/2011; 46(8):585-90. · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To determine the current level of knowledge of first aid for a burn injury and sources of this knowledge among the general population of New South Wales.
People aged 16 years or older were interviewed as part of the 2007 NSW Population Health Survey, a continuous telephone survey of NSW residents.
Weighted proportion of the population with optimal first aid knowledge for burns.
In total, 7320 respondents were asked questions related to burn injuries and first aid. Of the surveyed population, 82% reported that they would cool a burn with water, and 9% reported that they would cool the burn for the recommended 20 minutes. Few respondents reported that they would remove the patient's clothing and keep the injured person warm. The most common sources of first aid information were a first aid book (42%) and the internet (33%). Speaking a language other than English at home, and being over 65 years of age were associated with a lack of first aid knowledge.
A minority of people living in NSW know the optimal time for cooling a burn injury and other appropriate first aid steps for burns. This study demonstrates a gap in the public's knowledge, especially among non-English speaking people and older people, and highlights the need for a clear, consistent first aid message.
The Medical journal of Australia 10/2011; 195(8):465-8. · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are clear personal, social and environmental benefits of cycling. However, safety concerns are among the frequently cited barriers to cycling. In Australia, there are no exposure-based measures of the rates of crash or 'near miss' experienced by cyclists.
A prospective cohort study over 12 months, with all data collected via web-based online data entry.
Two thousand adults aged 18 years and older, living in New South Wales (Australia), who usually bicycle at least once a month, will be recruited from March to November 2011.
In the 12 months following enrolment, cyclists will be surveyed on six occasions (weeks 8, 16, 24, 32, 40 and 48 from the week of the enrolment survey). In these survey weeks, cyclists will be asked to provide daily reports of distance travelled; time, location and duration of trips; infrastructure used; crashes, near misses and crash-related injuries. Information on crashes and injuries will also be sought for the intervening period between the last and current survey. A subsample of participants will receive bicycle trip computers to provide objective measurement of distance travelled.
This study protocol describes the prospective cohort study developed to assess near misses, crashes and injuries among cyclists by time and distance travelled and by type of infrastructure used, with recruited participants entering data remotely using the internet. We expect to be able to calculate event rates according to exposure overall and for different infrastructure types and to report in-depth information about event causation.
[Show abstract][Hide abstract] ABSTRACT: Sports injuries are an important public health issue. A multi-agency key stakeholder partnership was formed to develop a state-wide response to sports injury prevention in New South Wales, Australia. This study evaluated the partnership approach to injury prevention policy development. The partnership approach to policy development was evaluated pre- and post-partnership using semi-structured telephone interviews and questionnaire data gathered from participants. Participants were satisfied with the partnership operation and outcomes. Challenges included: maintaining focus and efficiency; time constraints; sector diversity limiting the likelihood of addressing needs and reaching consensus; and ensuring commitment from all relevant organisations. Potential benefits included: a sense of policy ownership; a broad-based approach across the sector and savings from resource sharing. Policy resulted from a shared understanding of the injury problem, and of an appropriate response. A credible industry leader, investment in partnership management and a consultative approach facilitated the success of the partnership.
International Journal of Injury Control and Safety Promotion 08/2011; 19(2):115-22. · 0.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: To understand the conditions under which a group of women recruited from antenatal, mental health, and substance abuse services disclose abuse in response to routine screening for intimate partner violence and their constructions of the impact of routine screening. Method: In-depth interviews with 20 women followed up 6 months after disclosing abuse in response to screening. Results: Women were in diverse situations relating to trajectories of abuse that included continued abuse despite interventions and abuse cessation within relationship. Women disclosed their abuse after making active judgments about safety on three dimensions: from the abuser, from shame and from relinquishing control. Most women described valued impacts from screening, though this was less common for those who had previous contact with statutory agencies. The process of asking shaped constructions of abuse, giving name to it. Health workers' responses to disclosures often helped to create a sense of connection. Conclusions: These effects align with Herman's work identifying naming and reconnection as important steps in recovery from trauma. The diversity of women's situations may explain difficulties in achieving significant findings by RCTs on screening impacts. Screening can bring about important changes for some women and is not simply a strategy for identification and referral. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Psychology of Violence 03/2011; 1(2):150-162. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite the acute impact of road trauma involving novice drivers, there have been few efforts to identify the main factors influencing the novice driver policy agenda. Increasing the transparency of such policy dynamics may help inform future novice driver policy agenda-setting processes, as well as those in other public health settings.
Forty interviews were conducted between 2007 and 2009 with individuals involved in novice driver policy debates and processes in four Australian states.
An increasing body of positive evaluations from other jurisdictions was seen to provide an initial stimulus for Australian novice driver policy activities. The dissemination of evidence by researchers, lobbying and advocacy by other influential stakeholders, and media reporting of multiple-fatality novice driver crashes were seen as other factors central to policy agenda setting.
Australian graduated driver licensing (GDL) policy initiatives may only be acted upon once adequate political support is identified in terms of community demand for action and public acceptance of GDL policy in neighboring states. As such, researcher encouragement of community support for unpopular evidence-based policies during windows of opportunity for policy reform may act as an influential agenda-setting force.
Public health 03/2011; 125(4):217-21. · 1.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Routine screening for intimate partner violence (IPV) has been widely introduced in health settings, yet screening rates are often low. A screening policy was introduced statewide in Australia in antenatal, mental health, and substance abuse services. Annual snapshot indicates a sustained screening rate of 62%-75% since 2003. Focus group research with health care workers from 10 services found that initial introduction of screening was facilitated by brief, scripted questions embedded into assessment schedules, training, and access to referral services. Over time, familiarity and women's favorable reactions reinforced practice. Barriers remain, including lack of privacy, tensions about limited confidentiality, and frustration when women remain unsafe. Screening added to the complexity of work, but was well accepted by workers, and increased awareness of and responsiveness to IPV.
Violence and Victims 02/2011; 26(1):130-44. · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Routine screening of women for intimate partner violence (IPV) has been introduced in many health settings to improve identification and responsiveness to hidden abuse. This cross-sectional study aimed to understand more about how women use screening programmes to disclose and access information and services. It follows women screened in ten Australian health care settings, covering antenatal, drug and alcohol and mental health services. Two samples of women were surveyed between March 2007 and July 2008; those who reported abuse during screening 6 months previously (122) and those who did not report abuse at that time (241). Twenty-three per cent (27/120) of women who reported abuse on screening were revealing this for the first time to any other person. Of those who screened negative, 14% (34/240) had experienced recent or current abuse, but chose not to disclose this when screened. The main reasons for not telling were: not considering the abuse serious enough, fear of the offender finding out and not feeling comfortable with the health worker. Just over half of both the positive and negative screened groups received written information about IPV and 35% of the positive group accessed further services. The findings highlight the fact that much abuse remains hidden and that active efforts are required to make it possible for women to talk about their experiences and seek help. Screening programmes, particularly those with established protocols for asking and referral, offer opportunities for women to disclose abuse and receive further intervention.
Health & Social Care in the Community 11/2010; 18(6):671-80. · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Regulations to restrict the temperature of domestic hot tap water were introduced in NSW in 1999. This study investigates the impact of the regulations on the knowledge, attitude and practice of workforce professionals responsible for their uptake and enforcement. Telephone surveys were conducted with a random sample of 110 plumbers and 30 regulating authorities. Surveys were recorded, transcribed and coded. Written questionnaires were completed by 151 plumbing students. The regulations are well known and supported by the majority of plumbers, students and regulators; however 75% of plumbers reported customer dissatisfaction with them. Only a minority of plumbers (11%), students (7%) and regulators (27%) correctly appreciated the impact of a decrease in water temperature in reducing burns. This study identifies the need to improve plumbers and students' understanding of the safety issues underlying the regulations in order to promote more effective advocacy for homes not currently covered by the regulations, and to provide more public education to increase acceptance of them. As only houses built or substantially renovated after June 1999 are likely to have been impacted by the current regulations, there is a need to increase the scope of the regulations to include not only new installations, but also the replacement of existing heated water units if the goal of universal protection is to be achieved.
Burns: journal of the International Society for Burn Injuries 11/2010; 37(2):234-9. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Scalds from hot tap water are serious injuries that are potentially preventable by restricting the temperature of hot tap water delivery. In July 1999, regulations were introduced in NSW to require that all new hot water installations deliver water at temperatures not exceeding 50 degrees C to sanitary fixtures. This study investigates trends in hot tap water scald injury hospitalisations following the introduction of these regulations. Hot tap water scald cases for 1999-2007 were identified from hospitalisation data for all public and private hospitals in NSW. To investigate hot tap water scald hospitalisations over time, negative binomial regression analysis was performed. There were 845 hospitalisations for hot tap water scalds in NSW over the period of the study. Hospital admission rates for hot tap water scalds decreased by an estimated 6% (3.2-8.5, 95%CI) per year since the introduction of regulations. While those most at risk were infants, toddlers and the elderly, almost a third of hospitalisations were for adults (25-64 years). The majority of hot tap water scalds were sustained at home and a further 4% occurred in a residential institute or school. The majority of scalds were severe, and a quarter required admission for longer than a week. The introduction of regulations in NSW appears to have had a positive impact on the rates of hospitalisations for hot tap water scalds; however, scalds continue to cause significant morbidity and mortality. This highlights the need for a review of the scope and implementation of the existing regulations and ongoing education of the general public to the dangers of hot tap water.
Burns: journal of the International Society for Burn Injuries 09/2010; 36(6):912-9. · 1.95 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objectives: To determine acceptance, completion rates and immunogenicity of the standard vaccination schedule for hepatitis A (HAV) and B (HBV) in persons subject to homelessness.Methods: A convenience sample of clients (n=201) attending a medical clinic for homeless and disadvantaged persons in Sydney was enrolled. Serological screening for HAV and HBV was undertaken. An appropriate vaccination program was instituted. Post-vaccination serology determined serological response.Results: Although many clients had serological evidence of past infection, at least 138 (69%) clients had the potential to benefit from vaccination. For hepatitis A and B vaccinations, completion rates were 73% (73 of 100 clients) and 75% (69 of 92 clients), respectively; after vaccination, protective antibody was found in 98.2% (56 of 57) and 72% (36 of 50) of clients, respectively.Conclusion: A successful vaccination program can be mounted with a vulnerable population. We consider a clinic with a well-established history of acceptance and utilisation by the target group; a low staff turnover and regular clientele; inclusion of vaccination as part of routine client care; and counselling (part of pre- and post-serological testing) essential components in achieving good vaccination completion rates.
Australian and New Zealand Journal of Public Health 03/2010; 34(2):130 - 135. · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This evaluative study measured self-reported changes in abuse-related measures six months after routine screening for intimate partner violence. Participants were 122 women who disclosed abuse and 241 who did not report abuse, screened in antenatal, substance abuse, and mental health services according to an existing standardized protocol used in New South Wales, Australia. Six months after initial screening, abused women were more likely to report increased agreement with a number of attitudes relating to abuse, in particular that being hurt by a partner affects a woman's health and that health services should ask about abuse. The proportion reporting current abuse was significantly lower after six months. While 6% (7/119) reported negative emotional reactions, 34% (41/120) reported useful effects-most frequently re-evaluating their situation and reducing isolation. Women who had experienced abuse, but elected not to disclose it reported similar effects. The results of this study lend support to the use of protocols for asking about abuse and responding to disclosures of abuse.
Women & Health 03/2010; 50(2):125-43. · 1.05 Impact Factor