Kirsten J Mccaffery

The University of Sydney · School of Public Health

Background Plain language summaries (PLSs) are easyto-understand summaries of research articles that should follow principles of plain language and health literacy. PLS author instructions from health journals help guide authors on word count/PLS length, structure and the use of jargon. However, it is unclear whether published PLSs currently adhere...

Background Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care. This stud...

Objetivo: Cuando las personas reciben información sobre los beneficios y daños de la mamografía, no siempre la aceptan al pie de la letra y, en cambio, expresan escepticismo. El propósito de esta investigación fue identificar los impulsores psicológicos de este escepticismo. Se consideraron dos hipótesis basadas en teorías: una hipótesis propone qu...

Background and objectives Crash injury risk is reduced when a child correctly uses an appropriate restraint; however, incorrect restraint use remains widespread. The aim of this study was to determine whether product information developed using a user-driven approach increases correct child restraint use. Methods We conducted a two-arm double-blin...

Objective To (a) examine whether the effect of the Choosing Wisely consumer questions on question-asking and shared decision-making (SDM) outcomes differs based on individuals’ health literacy and (b) explore the relationship between health literacy, question-asking and other decision-making outcomes in the context of low value care. Methods Prepl...

Introduction Many types of prostate cancer present minimal risk to a man’s lifespan or well-being, but existing terminology makes it difficult for men to distinguish these from high-risk prostate cancers. This study aims to explore whether using an alternative label for low-risk prostate cancer influences management choice and anxiety levels among...

Background Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environmen...

Objectives Patient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding...

Background: The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years. Objective: To conduct a national probability-bas...

Introduction The German health technology assessment (HTA) agency Institute for Quality and Efficiency in Health Care (IQWiG) has recently published a preliminary HTA report on benefits and risks of shared deci-sion- making (SDM). It concludes there is no proven effect of SDM regarding morbidity, mortality, or health related quality of life. Theref...

Introduction Genomic settings are complex and challenging for informed decision making. Partnering with patients and professionals, we aimed to coproduce an innovative intervention for cancer patients to improve decision making and COnsent in GENomic Testing (CoGenT). Methods Developing the CoGenT intervention, incorporating an online Dynamic Cons...

Introduction Decision aid (DA) development requires expertise and resources to engage key stakeholders and meet the International Patient Decision Aids Standards (IPDAS). The PADA technology platform facilitates this process. Our aim was to assess users’ perceptions of the usability and sustainability of a minimal viable version of PADA. Methods I...

Introduction Robust evidence on the benefits and harms of breast density notification is required to inform current and future mammography screening policy and practice. This randomised controlled trial (RCT) aims to assess the effect of notifying women with dense breasts of their breast density on their psychosocial outcomes and health services us...

Introduction Online informaGon about AMH tesGng oIen has unfounded claims about its ability to predict ferGlity and concepGon, and evidence suggests women seek out and are recommended the AMH test as a measure of their ferGlity potenGal. This study aimed to co-design evidence-based informaGon about the AMH test and examine its impact on women’s int...

Objectives To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. Study design Systematic review and meta-analysis. Eligibility criteria Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults wit...

Aim To develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. Design Mixed-methods study describing the development of a patient decision aid. Setting A draft decision aid was developed by a multidisciplinary steering group (including various t...

Introduction Opioids and imaging are considered low-value care for most people with low back pain. Yet around one in three people presenting to the emergency department (ED) will receive imaging, and two in three will receive an opioid. NUDG-ED aims to determine the effectiveness of two different behavioural ‘nudge’ interventions on low-value care...

Introduction Western Sydney Diabetes (WSD) established an innovative diabetes service in May 2020, using virtual and in-person care, linking primary care with the diabetes specialist team. This study evaluated the service’s feasibility using qualitative and quantitative methods. Method Evaluation included: 1) thematic analysis of interviews and wo...

Background High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the evidence on the impact of breast density (BD) information and/or notification on women's psychosocial outcomes among women from racial and ethnic minority groups. Methods A systematic s...

Introduction Low back pain (LBP) is commonly treated with opioid analgesics despite evidence that these medicines provide minimal or no benefit for LBP and have an established profile of harms. International guidelines discourage or urge caution with the use of opioids for back pain; however, doctors and patients lack practical strategies to help t...

Background Most health information does not meet the health literacy needs of our communities. Writing health information in plain language is time-consuming but the release of tools like ChatGPT may make it easier to produce reliable plain language health information. Objective To investigate the capacity for ChatGPT to produce plain language ver...

Introduction: The purpose of our research was to explore how parents and their adolescent children make decisions about the human papillomavirus (HPV) vaccine, and to inform future interventions that aim to facilitate inclusive decision-making processes. Method: Purposive and snowball sampling strategies targeted parents and their adolescent childr...

Background Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as televi...

Objectives Robust evidence on the benefits and harms of breast density notification is required to inform future mammography screening policy and practice. This randomised controlled trial (RCT) aims to assess the effect of notifying women with dense breasts participating in population-based breast cancer screening in Australia of their breast dens...

Management of low-risk ductal carcinoma in situ (DCIS) is controversial, with clinical trials currently assessing the safety of active monitoring amidst concern about overtreatment. Little is known about general community views regarding DCIS and its management. We aimed to explore women’s understanding and views about low-risk DCIS and current and...

Objective To develop and user-test a patient decision aid portraying the benefits and harms of non-surgical management and surgery for Achilles tendon ruptures. Design Mixed methods. Setting A draft decision aid was developed using guidance from a multidisciplinary steering group and existing patient decision aids. Participants were recruited thr...

BACKGROUND Adolescence is a key developmental period that affects lifelong health and is impacted by adolescents regularly engaging with digital health information. Adolescents need digital health literacy (DHL) to effectively evaluate the quality and credibility of such information, and to navigate an increasingly complex digital health environmen...

Background: The Sydney Health Partners Emergency Department (SHaPED) trial targeted ED clinicians and evaluated a multifaceted strategy to implement a new model of care. The objective of this study was to investigate attitudes and experiences of ED clinicians as well as barriers and facilitators for implementation of the model of care. Design: A...

Using a cluster-randomized trial design, we aimed to evaluate a complex intervention to increase uptake of human papillomavirus (HPV) vaccination in schools. The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015 with adolescents aged 12-13 years. Interventions included education, shared decision-mak...

Introduction: Consistent evidence shows pathology services are overused worldwide and that about one-third of testing is unnecessary. Audit and feedback (AF) is effective for improving care but few trials evaluating AF to reduce pathology test requesting in primary care have been conducted. The aim of this trial is to estimate the effectiveness of...

Background: Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia's prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel and certain professions. However, several months into the pandemic half of Australians were still not getting tested for respirator...

BACKGROUND The COVID-19 pandemic has presented social and political challenges for vaccination communication. Despite high willingness to vaccinate, certain demographics have expressed higher rates of vaccine hesitancy, including young men in Australia who have traditionally been difficult to engage in health communication efforts. In the digital a...

Objective: The Sydney Health Literacy Lab (SHeLL) Editor is an online text-editing tool that provides real-time assessment and feedback on written health information (assesses grade reading score, complex language, passive voice). This study aimed to explore how the design could be further enhanced to help health information providers interpret an...

Background Health information is less effective when it does not meet the health literacy needs of its consumers. For health organisations, assessing the appropriateness of their existing health information resources is a key step to addressing this issue. This study describes novel methods for a consumer-centred large-scale health literacy audit o...

In the last decades, researchers, governments and public campaigns have increased awareness about healthcare overuse.1 Low-value care is described as care unlikely to benefit the patient given the harms, costs or available alternatives.2 Clinical practice guidelines with ‘do-not-do’ recommendations and other de-implementation strategies were promot...

Health authorities utilized social media during the COVID-19 pandemic to disseminate critical and timely health messages, specifically targeting priority groups such as young people. To understand how social media was used for this purpose, we investigated the content of COVID-19-related social media posts targeting young people (16-29 years old) s...

Background: Health literacy is an important aspect of equitable, safe, and high-quality care. For organisations implementing health literacy initiatives, using "change champions" appears to be a promising strategy. This systematic review aimed to identify the empirical and conceptual research that exists about health literacy champions. Methods: We...

Optimal patient care is directed by clinical practice guidelines, with emphasis on shared decision-making. However, guidelines –and interventions to support their implementation– often do not reflect needs of ethnic minorities who experience inequities in CKD prevalence and outcomes. This review aims to describe what interventions exist to promote,...

Producing health information that people can easily understand is challenging and time-consuming. Existing guidance is often subjective and lacks specificity. With advances in software that reads and analyzes text, there is an opportunity to develop tools that provide objective, specific, and automated guidance on the complexity of health informati...

The primary objective of this trial is to estimate the effectiveness of audit and feedback for reducing requests for 10 commonly overused combinations of pathology tests by high-requesting Australian general practitioners (GPs) compared with no intervention control. This includes requests for any combination of 2 or 3 pathology tests for Iron Studi...

Objective: The current study examined patterns in COVID-19 testing and vaccination intentions across multiple language groups in Greater Western Sydney, Australia. Methods: Participants completed a cross-sectional survey available from March 21 to July 9, 2021 in Sydney, Australia. Surveys were available in English or translated (11 languages). Par...

This cross-sectional study examines the variability of readability scores across widely used online calculators.

Background To investigate whether culturally and linguistically diverse (CALD) communities in Western Sydney have experienced any positive effects during the COVID-19 pandemic, and if so, what these were. Methods A cross–sectional survey with ten language groups was conducted from 21st March to 9th July 2021 in Sydney, Australia. Participants were...

Background: Low health literacy affects 25% of people with chronic kidney disease (CKD) and is associated with increased morbidity and death. Improving health literacy is a recognised priority, but effective interventions are not clear. Objectives: This review looked the benefits and harms of interventions for improving health literacy in people...

Objective: Discontinuation of, and non-adherence to, inhaled corticosteroids (ICS) for asthma treatment is a significant issue in pregnancy. This study characterised beliefs about medicines in pregnant women with asthma and investigated associations with ICS adherence. Methods: Pregnant women with relatively mild asthma (n = 302) were grouped ac...

Objectives and importance of study: Changing cancer screening programs is notoriously difficult and may be influenced by clinicians’ willingness to adhere to new guidelines. Our objective was to investigate clinicians’ adherence to revised cervical screening guidelines and to identify any reasons for testing outside the revised guidelines. Methods...

Background Health literacy interventions and research outcomes are not routinely or systematically implemented within healthcare systems. Co‐creation with stakeholders is a potential vehicle through which to accelerate and scale up the implementation of innovation from research. Methods This narrative case study describes an example of the applica...

Background Older adults should be supported to make informed decisions about cancer screening. However, it is unknown how general practitioners (GPs) in Australia communicate about cancer screening with older people. Aim To investigate GPs’ views and experiences of communicating about cancer screening (breast, cervical, prostate, and bowel) with o...

Background: The Anti-Mullerian hormone (AMH) test is promoted to women as a way to find out how long they have left to have children. However, data consistently show the test is a poor predictor of natural fertility potential for an individual woman. As fertility clinic websites are often a primary source of information for reproductive information...

Background: Plain language summaries (PLSs) are intended for a non-expert audience in order to make health research accessible and understandable to the public. This is important because most research is written with jargon and at a high reading level. However, there is a high degree of variability in the instructions for writing PLSs, which may i...

Background and purpose: Pregnant and breastfeeding women commonly use complementary medicine products (CMPs), including dietary supplements and herbal medicines. This study investigated women's reasons for use. Materials and methods A national, cross-sectional, online survey conducted between July–September 2019 investigated reasons for CMP use du...

Communicating health information quickly and effectively with diverse populations has been essential during the COVID-19 pandemic. However, health communication practices are often top down and poorly designed to rapidly meet diverse health literacy, cultural and contextual needs of the population. This paper describes a research and practice partn...

Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical bre...

Importance: Audit and feedback can improve professional practice, but few trials have evaluated its effectiveness in reducing potential overuse of musculoskeletal diagnostic imaging in general practice. Objective: To evaluate the effectiveness of audit and feedback for reducing musculoskeletal imaging by high-requesting Australian general practi...

Background Since the 1990s, most nations have had a reduction or stabilisation in prostate cancer mortality. However, socioeconomic differences in disease specific mortality and survival have persisted. This has been partially attributed to differences in treatment choices. The aim of this systematic review and meta-analysis was to describe and qua...

Background: There is a lack of evidence around Australian general practitioners' (GPs) views of issues surrounding breast density. The current study aimed to quantitatively assess GPs' current knowledge, understanding, and feelings around breast density information and notification. Methods: This study involved a cross-sectional survey using an...

Background: Recent observational studies suggest that vaccines may have little effect in preventing infection with the Omicron variant of severe acute respiratory syndrome coronavirus 2. However, the observed effects may be confounded by patient factors, preventive behaviours, or differences in testing behaviour. To assess potential confounding, w...

Introduction Asthma exacerbations in pregnancy are associated with adverse perinatal outcomes. We aimed to determine whether fractional exhaled nitric oxide (FENO)-based asthma management improves perinatal outcomes compared to usual care. Methods The Breathing for Life Trial was a multi-center, parallel group, randomised controlled trial conducte...

Objective: People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes. Methods:...

Background Although there is some qualitative research on physiotherapists’ experiences of delivering low back pain treatment, we do not know the extent that these findings apply to low back pain prevention. Objective To explore physiotherapists’ understanding, attitudes and experiences related to delivering low back pain prevention programs. Des...

BACKGROUND Polymerase chain reaction (PCR) testing for COVID-19 was crucial in Australia’s prevention strategy in the first 2 years of the pandemic, including required testing for symptoms, contact with cases, travel, and certain professions. However, several months into the pandemic, half of Australians were still not getting tested for respirator...

Background The internet and social media are increasingly popular sources of health information for adolescents. Using online health information requires digital health literacy, consisting of literacy, analytical skills and personal capabilities such as self-efficacy. Appraising trustworthiness and relevance of online health information requires c...

Importance: Whether the benefits of notifying women about breast density outweigh the potential harms to inform current and future mammogram screening practice remains unknown. Objective: To assess the effect of mammographic breast density notification and information provision on women's intention to seek supplemental screening and psychologica...

Objectives To explore experiences of women who identified themselves as having a possible breast cancer overdiagnosis. Design Qualitative interview study using key components of a grounded theory analysis. Setting International interviews with women diagnosed with breast cancer and aware of the concept of overdiagnosis. Participants Twelve women...

Objectives DCIS is a breast malignancy contained within the milk ducts. Prognostic uncertainty means discussing DCIS and its treatment are challenging. Recognition that some DCIS lesions might remain indolent for many years has led to concern about overtreatment, with international clinical trials underway assessing the safety of active monitoring...

Objectives Current practice monitors women with low-grade cervical abnormalities at 12 months later, but women with high-grade cervical abnormalities (cervical intraepithelial neoplasia (CIN) 2 and 3) routinely receive immediate treatment to remove abnormal cells. There is evidence of increased risk of obstetric complications following invasive tre...

Background We developed a smartphone app—the SUCCESS (Supporting Culturally and Linguistically Diverse CKD Patients to Engage in Shared Decision-Making Successfully) app—to support Australian adults with kidney failure undertaking dialysis to actively participate in self-management and decision-making. The content of the SUCCESS app was informed by...

Central to a successful population vaccination program is high uptake of vaccines. However, COVID-19 vaccine uptake may be impeded by beliefs based on misinformation. We sought to understand the prevalence and nature of misbeliefs about COVID-19 vaccines, and identify associated factors, shortly after commencement of Australia’s national vaccine ro...

Objectives The anti-Mullerian Hormone (AMH) test is a blood test indicating ovarian reserve (i.e. the number of eggs left in a woman’s ovaries). The test is helpful in assisted reproduction (indicates the potential number of oocytes retrieved for in vitro fertilisation or egg freezing). However, studies have found that the test cannot reliably pred...

Background Subacromial decompression surgery and rotator cuff repair surgery are often used to treat shoulder pain but evidence suggests these surgeries provide limited clinical benefit and may cause harm. We developed a patient decision aid – guided by the International Patient Decision Aids Standards (IPDAS) – that presents evidence-based informa...

Objectives Older adults continue to be screened for cancer with limited knowledge of the potential hams. In Australia, general practitioners (GPs) may play an important role in communication and decision-making around cancer screening for older people. The aim of this study was to investigate GP’s attitudes and behaviours regarding cancer screening...

Objectives Organised breast screening has greatly increased DCIS incidence. Recognition that some DCIS lesions might remain indolent for many years has led to concern about overtreatment, and international clinical trials are currently assessing the safety of active monitoring for low-risk DCIS. Women may not be aware of what DCIS is and the dilemm...