Australian Capital Territory Research Articles

Outcomes of lowered newborn screening thresholds for congenital hypothyroidism.

Newborn screening (NBS) has largely eliminated the physical and neurodevelopmental effects of untreated congenital hypothyroidism (CH). Many countries, including Australia, have progressively lowered NBS bloodspot thyroid-stimulating hormone (b-TSH) thresholds. The impact of these changes is still unclear. To evaluate the performance of CH NBS following the reduction of b-TSH thresholds in New South Wales (NSW) and the Australian Capital Territory (ACT), Australia, from 15 to 8 mIU/L, and to determine the clinical outcomes of cases detected by these thresholds. NBS data of 346 849 infants born in NSW/ACT, Australia from 1 November, 2016-1 March, 2020 inclusive were analysed. A clinical audit was conducted on infants with a preliminary diagnosis of CH born between 1 January, 2016-1 December, 2020 inclusive. The lowered b-TSH threshold (≥8 mIU/L, ~99.5th centile) detected 1668 infants (0.48%), representing an eight-fold increase in recall rate, of whom 212 of 1668 (12.7%) commenced thyroxine treatment. Of these 212 infants, 62 (29.2%) (including eight cases with a preliminary diagnosis of thyroid dysgenesis) had an initial b-TSH 8-14.9 mIU/L. The positive predictive value for a preliminary diagnosis of CH decreased from 74.3% to 12.8% with the lowered threshold. Proportionally, more pre-term infants received a preliminary CH diagnosis on screening with the lower threshold (16.1% of 62) than with the higher threshold (8.0% of 150). Clinically relevant CH was detected using the lowered threshold, albeit at the cost of an eight-fold increase in recall rate. Further clinical and economic studies are required to determine whether benefits of lowered screening thresholds outweigh potential harms from false-positive results on infants, their families and NBS programs.

Survey of Neonatal Resuscitation Practices in Metropolitan and Nonmetropolitan Nontertiary Birthing Units in New South Wales and Australian Capital Territory

Objective To describe the neonatal training experience of birth attendants in New South Wales (NSW) and Australian Capital Territory (ACT) and explore the variations in respiratory management and equipment use at birth. Methods We contacted 119 nontertiary units in NSW/ACT by a written survey followed by telephone contact. A set questionnaire was offered, asking for details of the availability and skill levels of staff at neonatal resuscitation, and of the equipment available at all births. Results Staff from 103 out of 119 units (87%) participated in the study. Resuscitation at all metropolitan units was supported by qualified pediatricians whereas midwives provided neonatal resuscitation as the first responder in a nonmetropolitan unit, with support from a general medical practitioner. Twenty-two percent of nontertiary units relied on external agencies or online support for neonatal resuscitation training. Three quarters of the units used a T-piece resuscitator as the primary device to provide positive pressure ventilation, 65.3% of nonmetropolitan units had blenders available, and 19% of units administered some oxygen at initiation of resuscitation. Thirty-eight percent units responded having no prior knowledge of the pressure relief valve setting. Conclusion Equipment and availability of trained personnel for neonatal resuscitation in nontertiary birthing units across NSW and ACT vary widely. The resources to provide training and education are variable.

Long-acting reversible contraception prescribing coverage by nurse practitioners and midwives in Australia

BackgroundExpanded patient access to long-acting reversible contraception (LARC) is needed to support patient choice and access to efficacious forms of contraception. Little is known about nurse practitioner (NP) and midwife LARC prescribing. AimsTo examine LARC prescribing by NPs and midwives in Australia. MethodsA cross-sectional study of Australian Pharmaceutical Benefits Scheme dispensing data from 2018 to 2021 for females aged 15–54. Age‐standardised rates were calculated by state, remoteness area, and level 3 statistical areas (SA3s). FindingsDespite a 1.6 fold increase since 2018, NPs and midwives accounted for 0.82 % (n = 2184) of prescriptions for LARC dispensed in 2021. The percentage of services in 2021 was greater in outer regional (2.21 %) and lowest in major cities (0.68 %) and was higher for the implant (0.92 %) compared with the hormonal intrauterine device (0.76 %). The proportion of total SA3s where a NP/midwife prescribed LARC increased from 23.35 % in 2018 to 29.94 % in 2021. NP/midwife LARC prescribing was highest in outer regional (42.6 %) and lowest in remote areas (18.8 %). When stratified by state/territory, coverage of SA3s was highest in Australian Capital Territory (50.0 %) and lowest in the Northern Territory (11.1 %). Discussion and conclusionOur findings suggest that whilst there has been an increase in NP and midwife LARC prescribing, the overall rate remains low and coverage across Australia appears fragmented. NPs and midwives are well placed to enhance women’s access to efficacious forms of contraception, but this requires future efforts to identify and address critical barriers (e.g. legislative, funding, training) to service provision.

Framework for Implementing and Measuring Interoperability and Organizational Change Within and Across a Multi-service and Multi-agency Emergency Response System

Introduction:The Australian Capital Territory Emergency Services Agency (ESA) has experienced a significantly increased burden of training and most significantly recurrent major emergency response events correlated with increased bushfire and extreme weather events since 2019. ACT ESA is required to provide comprehensive pre-hospital paramedic, firefighting, and emergency response support to the population of the Australian Capital Territory on a day-by-day basis (business as usual) but also surge to meet extraordinary demand. Historically, operational roles and functional areas within ACT ESA have worked largely autonomously under business-as-usual conditions. Under crisis or disaster conditions, these sub-agencies are required to work harmoniously together and alongside external agencies such as Australian Defense Force and Australian Federal Police. ACT ESA have identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. From 2023-2027 ACT ESA has committed to a program of organizational change to address this problem.Method:An organizational change plan focusing on improving interoperability and integration was developed using the Generalized Method for Measuring Interoperability and Continuous Quality Improvement frameworks. A comprehensive framework for measuring organizational change and the effectiveness of interventions across multiple workplace domains, based on Kirkpatrick’s approach, was developed through a co-design process between academia and the ACT ESA.Results:The ACT ESA change management framework, research, and implementation plan is presented here, alongside the results of preliminary stakeholder and professional engagement activities providing early feedback, adjustment and evolution.Conclusion:The ACT ESA is in a unique position within the Australian emergency response landscape having a much greater degree of centralized command, control, and coordination. Despite this advantage, it has identified interoperability both within the organization and with key partnering organizations as a problem. This study outlines how the ESA is approaching organizational change by applying systematic implementation and change management approaches.

Framework and Thematic Analysis of Historical After Action Review Reports from the Australian Capital Territory Emergency Services Agency

Introduction:Emergency services organizations routinely undertake internal quality improvement activities following training and operational activities. One form of a quality improvement activity is the After Action Review (AAR). An AAR is a facilitator-led post-event review where data is collected from individuals and groups of individuals using either surveys, focus group-like meetings, or individual interviews. Data is collected using a semi-structured data collection tool which is usually customized to the specific tasks being reviewed and the priorities and goals of the organization. The quality of AARs has been noted to vary significantly across organizations with reporting biases and differences between exercise or real event AARs and biases introduced by utilization of internal rather than external evaluators, and limited justification for data selection and collection rationales. The Australian Capital Territory Emergency Services Agency (ACT ESA) has identified that interoperability and integration between internal ACT ESA sub-agencies and externally with other agencies is a key problem. The aim of this study was to identify specific areas of consistent interoperability concern through the examination of historical AARs.Method:In this qualitative study a Framework Analysis of historical AAR text documents was conducted, following the standard five step process. This was followed by detailed thematic analysis in aggregate and examined longitudinally, with emergent themes undergoing further analysis.Results:AARs relating to major emergency response and training activities 2016-2022 were examined. There was a substantial variation in quality, level of detail, completeness and structure across the different AAR documents. Consistent themes emerging from the data highlighted concerns regarding inter-agency culture, uncertainty when conducting joint activities and its impact on decision making, logistics concerns, resourcing and breakdown of shared understanding and communication between teams.Conclusion:Despite a centralized command structure, historical AAR analysis shows ACT ESA has had persistent operationally impacting interoperability and integration problems within the organization and with external agencies.

Understanding Urban Green Spaces Typology’s Contribution to Comprehensive Green Infrastructure Planning: A Study of Canberra, the National Capital of Australia

The urban densification agenda for the Australian Capital Territory announced in 2012 as well as the climate-related impacts (such as flood and rising temperature) have made the role of green infrastructure in this city more critical than at any other time. The Living Infrastructure Plan for Canberra was proposed by the local government in 2019 and it is currently being developed. However, there is a lack of understanding of the variety of urban green infrastructure characters, associated urban green space types, and their contributions to the green infrastructure plan. Therefore, this research aims to study the existing types of urban green infrastructure and green spaces in Canberra and investigate their potential sociocultural and ecological contributions that need to be considered in developing green infrastructure plans. To achieve this, we employed a socioecological approach and a mix of methods including a literature review, a review of policy documents, semi-structured interviews with experts, geospatial data, and field observation. Ten main urban green infrastructures were identified in Canberra and associated green spaces and their ecosystem services were discussed. Finally, a framework was delineated to suggest recommendations for the identified urban green infrastructure types with the aim of improving the green infrastructure planning practice by enhancing, preserving, and reinforcing green spaces. The findings provide a foundation for coordinating green infrastructure decision making and suggest a framework for designing high-quality and multifunctional green spaces. The study concludes that further investigation is required to comprehend the diversity of urban green infrastructures and their ecosystem services, co-benefits, synergies, and trade-offs.

Convolutional Neural Network Shows Greater Spatial and Temporal Stability in Multi-Annual Land Cover Mapping Than Pixel-Based Methods

Satellite imagery is the only feasible approach to annual monitoring and reporting on land cover change. Unfortunately, conventional pixel-based classification methods based on spectral response only (e.g., using random forests algorithms) have shown a lack of spatial and temporal stability due, for instance, to variability between individual pixels and changes in vegetation condition, respectively. Machine learning methods that consider spatial patterns in addition to reflectance can address some of these issues. In this study, a convolutional neural network (CNN) model, U-Net, was trained for a 500 km × 500 km region in southeast Australia using annual Landsat geomedian data for the relatively dry and wet years of 2018 and 2020, respectively. The label data for model training was an eight-class classification inferred from a static land-use map, enhanced using forest-extent mapping. Here, we wished to analyse the benefits of CNN-based land cover mapping and reporting over 34 years (1987–2020). We used the trained model to generate annual land cover maps for a 100 km × 100 km tile near the Australian Capital Territory. We developed innovative diagnostic methods to assess spatial and temporal stability, analysed how the CNN method differs from pixel-based mapping and compared it with two reference land cover products available for some years. Our U-Net CNN results showed better spatial and temporal stability with, respectively, overall accuracy of 89% verses 82% for reference pixel-based mapping, and 76% of pixels unchanged over 33 years. This gave a clearer insight into where and when land cover change occurred compared to reference mapping, where only 30% of pixels were conserved. Remaining issues include edge effects associated with the CNN method and a limited ability to distinguish some land cover types (e.g., broadacre crops vs. pasture). We conclude that the CNN model was better for understanding broad-scale land cover change, use in environmental accounting and natural resource management, whereas pixel-based approaches sometimes more accurately represented small-scale changes in land cover.

Social norms or enforcement? A natural field experiment to improve traffic and parking fine compliance

Very little is known about the efficient collection of fines despite their indispensable contribution to local government budgets. This paper fills an important gap in the literature by studying the effectiveness of deterrence (enforcement) and non-deterrence (social norms) letters that aim to improve the collection of traffic and parking fines. We present results from a natural field experiment implemented in collaboration with the Australian Capital Territory (ACT) Government. We find that both letters increase fine payments significantly. The effect of the enforcement letter is stronger than that of the social norms letter. Our analysis of heterogenous treatment effects indicates that addressing social norms does not change the behavior of young offenders, those who committed a speeding offence, those with a long outstanding debt and those with a debt above the median. In contrast, the enforcement letter is generally effective across subgroups.

Patterns of mental health care provision in urban areas: A comparative analysis for local policy in the ACT.

Urbanisation presents specific mental health challenges, requiring a better understanding of service availability in urban areas for mental health care planning. Our objective is to analyse patterns of urban mental healthcare provision in Australia, and compare these with relevant national and international regions to inform urban mental healthcare policy and planning. Following a health ecosystems approach, we use a standardised service classification instrument, the Description and Evaluation of Services and DirectoriEs (DESDE), and Mental Health Care Atlases, to compare the availability, bed capacity and diversity of services providing specialised mental health or psychosocial care that are universally accessible (ie provided at no or low cost only in all relevant care sectors in four Australian and three international urban regions. We used a heuristics approach and an homogeneity test. Applicability to local policy was assessed using the Adoption Impact Ladder. Community care was less developed in Australia than internationally, except in the case of residential care in Australian Capital Territory, our reference area. Alternatives to hospitalisation were scarce across all regions. The Atlas was applicable to regional and local mental health planning. Differences in pattern of care between regions has implications for planning, equality of access to care and prioritisation of resources. An ecosystems approach is relevant to service planning in mental healthcare at local level.

Rethinking prison visitation for children with incarcerated parents: Lessons from the Australian Capital Territory

Children of incarcerated parents experience a range of vulnerabilities which have led to them being dubbed the ‘invisible victims’ of the criminal justice system. This article discusses the needs of children with incarcerated parents using recent literature describing children’s experiences during prison visitation suspensions caused by the COVID-19 pandemic. We then critically examine the human rights-based communications framework, as well as the challenges faced by children of incarcerated parents, in the Australian Capital Territory (ACT). We recommend corrective services around Australia retain alternative contact methods and consider introducing in-cell communication technology.

Gambling on Development: Why some Countries Win and Others Lose, StefanDercon, Hurst, London, 2022, Pp. 398 + xiv, ISBN 9781787 385627

Asian-Pacific Economic LiteratureEarly View BOOK REVIEW Gambling on Development: Why some Countries Win and Others Lose, Stefan Dercon, Hurst, London, 2022, Pp. 398 + xiv, ISBN 9781787 385627 Hal Hill, Corresponding Author Hal Hill Professor [email protected] Australian National University, Canberra, Australian Capital Territory, Australia Hal Hill, Australian National University, Canberra, Australian Capital Territory, Australia. [email protected]Search for more papers by this author Hal Hill, Corresponding Author Hal Hill Professor [email protected] Australian National University, Canberra, Australian Capital Territory, Australia Hal Hill, Australian National University, Canberra, Australian Capital Territory, Australia. [email protected]Search for more papers by this author First published: 02 April 2023 https://doi.org/10.1111/apel.12374Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Exercise during CHemotherapy for Ovarian cancer (ECHO) trial: design and implementation of a randomised controlled trial

IntroductionEpidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting....

Experimental investigation of water retention curves of municipal solid wastes with different paper contents, dry unit weights and degrees of biodegradation

This paper investigates the drying and wetting water retention curves (WRCs) of municipal solid wastes (MSWs) with different paper contents, dry unit weights and degrees of biodegradation (DOBs). Fresh synthetic samples were prepared based on the field composition of the MSWs at Mugga Lane Landfill, the Australian Capital Territory (ACT), Australia. The degraded samples were prepared in simulators with MSWs of different initial dry unit weights and decomposition periods with leachate recirculation. The water retention curves (WRCs) of the MSWs were determined using pressure plate tests, in both drying and wetting phases. The outflow from MSWs was analysed using Gardner’s method to obtain the unsaturated hydraulic conductivity. The results indicate that the WRCs of the MSWs are greatly affected by the DOB, paper content and dry unit weight. When DOB < 30 %, as DOB increases, the air-entry pressure of MSWs with paper increases, and the residual moisture content decreases regardless of paper content. With DOB > 30 %, the air entry pressure and residual water content depend on the balance between organic matter and highly decomposed organic constituents. The paper content affects the WRCs of MSWs due to its water retention capacity and change in the particle size distribution with decomposition. The increase in the dry unit weight of MSWs significantly increases the air entry pressure and residual moisture content, similar to the borehole samples with combined effects of biodegradation and increase in stress level from literature. Hysteresis effects have been observed during the drying and wetting of MSWs. The hysteresis of WRCs increases with the paper content and DOB.

Targeting 1.5 degrees with the global carbon footprint of the Australian Capital Territory

In 2019 the Australian Capital Territory (ACT) government stated an ambition to prioritise reduction of Scope 3 greenhouse gas emissions, the size of which had not been fully quantified previously. This study calculated the total carbon footprint of the ACT in 2018, including Scope 1, 2 and 3 emissions and modelled scenarios to reduce all emissions in line with a 1.5 °C target approach. This is the first time a multi-scale analysis of local, sub-national and international supply chains has been undertaken for a city, using a nested and trade-adjusted global multi-region input-output model. This allowed for the quantification of global origins and destinations of emissions, which showed that the 2018 carbon footprint for the ACT was approximately 34.7 t CO2-eq/cap, with 83% attributed to Scope 3. Main contributions came from transport, electricity, manufacturing and public administration and safety, with emissions generated primarily in Australian States and Territories. Modelling in accordance with a 1.5 °C warming scenario showed a plausible reduction to 5.2 t CO2-eq/cap by 2045 (excluding offsets or carbon dioxide removal technologies), with remaining emissions predominantly embodied in international supply chains. This study demonstrates the radical changes required by a wealthy Australian city to achieve 1.5 °C compliance and identifies sectors and supply chains for prioritising policies to best achieve this outcome.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Harnessing fast and slow thinking to ensure sustainability of general practice and functional universal health coverage in Australia.

Interprofessional collaboration within general practice teams following the inclusion of non-dispensing pharmacists

BackgroundPharmacists have been included in general practice teams to provide non-dispensing services in the Australian Capital Territory (ACT) since 2016. Interprofessional collaboration and team effectiveness are key considerations in providing high-quality patient care. These concepts have not been well studied following the inclusion of a pharmacist in general practice teams.MethodsA mixed methods study was conducted to explore collaboration between pharmacists and health professionals in eight general practices in the ACT, where pharmacists were included in their teams. A validated survey instrument was adapted and utilised to assess the changes in interprofessional collaboration over time following the addition of a pharmacist. Another validated survey was utilised to explore team effectiveness at the end of the study. Semi-structured interviews, with a thematic analysis, were conducted with a purposeful sample of general practice staff members to understand the factors influencing the development of interprofessional collaboration.ResultsIn total, 56 and 41 participants completed the baseline and follow-up survey, including 26 who completed both surveys to assess the change in collaboration over time. Interprofessional collaboration scores were high initially and did not change over time. Team effectiveness was also high at the end of the study. Twenty-one individuals participated in interviews, which generated four main interrelated themes related to interprofessional collaboration: professional working relationships, trust, commitment to collaboration, and barriers to collaboration. Trust was integral to professional working relationships and commitment to collaboration. The barriers to collaboration included not having a role description for pharmacists, inadequate interest to initiate working relationships, lack of dedicated time for interaction, lack of utilisation, and poor awareness of pharmacist-led activities in general practice.ConclusionInterprofessional collaboration was initially high and not influenced by the addition of a pharmacist, perhaps reflecting the inherent nature of the general practices willing to include a pharmacist within their team. Introducing a clear job description for pharmacists, and dedicating time to interact with pharmacists, could be beneficial in improving trust and professional working relationships and enhancing collaboration between the pharmacists and other general practice team members.

Relationship between residential aged care facility characteristics and breaches of the Australian aged care regulatory standards: non-compliance notices andsanctions.

To examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards. Facility-level analysis of audits, sanctions and non-compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks. Non-compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non-compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non-compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non-compliance notices and sanctions, no significant relationship was found with RACF ownership type. We partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non-compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements.

The impact of tableside ordering technologies on alcohol sales to the intoxicated.

The impact of tableside ordering technologies on alcohol sales to the intoxicated.

The long road to introduce drug checking as a harm reduction strategy in Australia.

Emergency Medicine AustralasiaVolume 35, Issue 2 p. 341-343 Trainee Focus The long road to introduce drug checking as a harm reduction strategy in Australia David Caldicott BSc (Hons), MBBS, FRCEM, DipMedTox, Corresponding Author David Caldicott BSc (Hons), MBBS, FRCEM, DipMedTox Emergency Consultant, Senior Lecturer [email protected] Emergency Department, Calvary Public Hospital Bruce, Canberra, Australian Capital Territory, Australia ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia Correspondence: Associate Professor David Caldicott, Emergency Department, Calvary Public Hospital Bruce, 5 Mary Potter Circuit, Bruce, ACT 2617, Australia. Email: [email protected]Search for more papers by this author David Caldicott BSc (Hons), MBBS, FRCEM, DipMedTox, Corresponding Author David Caldicott BSc (Hons), MBBS, FRCEM, DipMedTox Emergency Consultant, Senior Lecturer [email protected] Emergency Department, Calvary Public Hospital Bruce, Canberra, Australian Capital Territory, Australia ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia Correspondence: Associate Professor David Caldicott, Emergency Department, Calvary Public Hospital Bruce, 5 Mary Potter Circuit, Bruce, ACT 2617, Australia. Email: [email protected]Search for more papers by this author First published: 02 March 2023 https://doi.org/10.1111/1742-6723.14193Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume35, Issue2April 2023Pages 341-343 RelatedInformation

Usage behavior of mHealth service users in Australia: do user demographics matter?

PurposeMobile health (mHealth) service is an Australian Government initiative aiming to improve the quality of health-care services. However, little is known about Australian health consumers’ willingness to adopt mHealth. The purpose of this paper is to study the usage behavior of mHealth service users in Australia. While various factors may impact users’ willingness to accept mHealth, this research investigates factors influencing the mHealth adoption decisions of the Australian health-care consumers, and the moderating impact of demographic factors on the usage behavior (UB) of mHealth services which has been rarely addressed in an Australian setting in the past.Design/methodology/approachThe theoretical framework is based on the technology acceptance model (TAM). Data were collected from residents of the Australian Capital Territory using a survey questionnaire and examined using partial least squares structural equation modeling.FindingsThe proposed mHealth usage model demonstrated a good fit and indicated that perceived usefulness, perceived ease of use, social influence, service quality and government influence are critical issues shaping mHealth UB. The moderation analysis revealed that users’ demographics, namely, gender, age and education are instrumental in broadening the understanding of UB of mHealth service in Australia.Practical implicationsThe findings will inform health-care service providers about the critical importance of the key factors driving the usage of mHealth services. Health-care providers and relevant authorities can develop targeted communication strategies that maximize the acceptance of mHealth services. Furthermore, deeper understanding of users’ demographic profiles would enable health-care service providers to promote their services to the right clients.Originality/valueThe above findings on the factors and user demographics informing the usage of mHealth services have unique practical, contextual and theoretical implications.