Expert Advisory Group Research Articles

Large scale public health system transformation: Ireland

Abstract Ireland has coped comparatively well with the COVID-19 pandemic when considering excess mortality. The reasons are likely complex and multifaceted, but it may be, in part, attributable to a comparatively young population and progress on indicators related to premature mortality and preventable mortality on chronic diseases and lifestyle risk factors. “Healthy Ireland” is a national framework in place since 2013 and utilizes a settings based approach to promote health and wellbeing in communities. It aims to improve collaboration between government, institutions, local communities, and individuals. Sláintecare is an all’party long-term health reform initiative developed in 2017 aimed at delivering the right care, at the right time, in the right place by the right team. In addition, in 2018 Ireland embarked on an ambitious public health reform programme with the implementation of the recommendations of the Crowe Horwath review of Public Health. While challenges exist, including access to services and waiting times, the governments has put in place initiatives to address these and is committed to, amongst other things, promo ting the continued integration of services across a variety of domains including primary to quaternary prevention. As Ireland began to emerge from the COVID-19 pandemic it established “The Public Health Reform Expert Advisory Group” to identify learnings from the public health components of the response, with a view towards strengthening public health and health protection generally and, specifically, future public health pandemic preparedness. The group, made up of national and international public health experts, submitted its final report in September 2023 which outlined a series of recommendations focused on potential improvements to public health policy, structures and governance. The WHO analysis of the Essential Public Health Functions provided complementary results. More work is now ahead to consider and implement these recommendations and foster institutional reforms including at the Health Services Executive, the Department of Health, and at the Health Protection Surveillance Centre.

An Irish public health policy research team: impact and lessons learned, one year on

Abstract Issue In 2023, in Ireland, a public health policy research team was established in the Health Information and Quality Authority to conduct evidence syntheses and provide evidence-based advice to inform national decision-making, at the request of the Department of Health. One year on, we reflect on the impact of this team and outline lessons learned. These findings may support other countries in creating and developing public health policy research teams. Description of the problem We aim to answer the following questions: What impact can a public health policy research team have and what are the lessons learned, one year on? Projects completed by the team in 2023 were reviewed for stakeholder engagement (such as expert and public and patient involvement) and impact (feedback from policymakers, resulting public health actions or policies and online report downloads). Results Seven public health projects were completed in 2023, in areas including: Long COVID, public health reform, rapid multiplex testing, and medical countermeasure stockpiling. National and international stakeholders were engaged with via expert advisory group membership, document review and project presentations. Patient representatives were included from Long COVID Advocacy Ireland and Rare Diseases Ireland. Project reports were downloaded a total of 281 times. Positive feedback was received from all stakeholders. Project findings were presented to policymakers to inform national public health and rare disease strategy development, and the Long COVID model of care in Ireland. Lessons Early and ongoing stakeholder engagement is key when translating research to practice, via policy. Innovative methods of engagement, including public and patient involvement, can ensure meaningful collaboration. Adapting methodologies to meet stakeholder needs, such as rapid evidence synthesis, enhances impact. Lastly, research impact on policy takes time, and an understanding of national policy development is required. Key messages • A public health policy research team provides impactful evidence synthesis to advise national policymakers. • Stakeholder engagement is key to developing impactful policy advice.

Emerging Infectious Disease Outbreak Response: Exploring the Sensemaking Process of an Expert Advisory Group

ABSTRACTThe COVID‐19 pandemic has highlighted the importance of crisis research, particularly in the response phase. This research explores long duration crisis sensemaking of an Expert Advisory Group (EAG) during an emerging disease outbreak which has implications for the conduct of COVID‐19 public inquiries. The members of the Ontario SARS Scientific Advisory Committee (OSSAC) for the 2003 SARS outbreak in Canada, provide the context for this study. Among their duties, these experts were tasked to write directives (mandated protocols) that govern all aspects of hospital life, such as the protocol for transferring SARS patients. Data were collected in multiple forms, including: public inquiry reports, meeting minutes, newspaper articles, and interviews. Following a constructivist grounded theory strategy, several iterations of data collection and analysis were completed. The findings include a conceptual framework that depicts the sensemaking process and illuminates the relationship between retrospective (after an event has occurred) and prospective (future‐oriented) sensemaking.

Parents’ experiences of perinatal child protection processes: A systematic review and thematic synthesis informed by a socio-ecological approach

BackgroundNationally and internationally, researchers and practitioners are increasingly expressing concerns regarding the number of babies removed by child protection systems soon after birth and how child protection processes in the perinatal period (conception to one year following birth) impact families. AimThis systematic review synthesises qualitative studies to gain an understanding of the experiences and needs of pregnant women, mothers, and fathers involved in perinatal child protection processes that occur in health, welfare, and legal systems. MethodsMulti-disciplinary electronic databases (13) were searched for relevant peer-reviewed journal articles written in English and published since 2000. Twenty-four articles met the inclusion criteria. Analysis adopted a socio-ecological approach and thematic synthesis. An expert advisory group comprised of lived experience advisors, service providers, and academics contributed to development of the thematic framework. ResultsAlthough the reviewed studies were conducted between 2005 and 2023 with diverse participants from six countries, they highlight parents’ similar experiences of perinatal child protection processes. Parents’ experiences are synthesised according to spheres of the socio-ecological model:(i) At the individual level, parents described their love, hope, confusion, fear, agency, and anguish.(ii) Within relationships parents recounted broken parent-baby bonds, limited personal and professional support, and the implications of trauma and trust for parent-professional relationships.(iii) When engaging with organisations parents reported pervasive surveillance and harmful processes, inadequate communication and support, and power imbalances.(iv) At policy and societal levels parents’ experiences pointed to dominant Western norms and values, increased poverty and homelessness, compromised rights, and prejudicial perinatal policies.Also synthesised are parents’, professionals’, and researchers’ recommendations for improving perinatal child protection processes and supporting families. ConclusionsOver the last 20 years, qualitative studies from around the globe have consistently reported the adverse biopsychosocial impacts of removing babies from their families. Addressing poverty and trauma, redressing power imbalances, and mitigating the enduring impact of perinatal child protection processes is critical for parents’ to be able to keep or be reunified with their babies. Shifts at institutional, policy, and societal levels are needed to: prioritise prevention and early intervention; enable relational practice and cross-sector collaboration; and move beyond traditional Western notions of family. Centring parents’ voices in efforts to improve child protection processes before and after birth will help inform the delivery of early and appropriate support to meet parents’ identified needs and promote family wellbeing.

Navigating high-cost medicines: summary of the Guiding Principles for the governance of high-cost medicines in Australian hospitals.

High-cost medicines (HCMs) can be clinically impactful for individual patients but are also subject to variable funding mechanisms. Public hospitals and health services are often asked to fund HCMs, but inconsistent processes frequently create large variations in care. CATAG (Council of Australian Therapeutic Advisory Groups) is the Australian peak national advisory body for the quality use of medicines in hospitals and health services, with all states and territories collaborating to support Drug and Therapeutics Committees (DTCs). CATAG has developed national Guiding Principles to assist DTCs to effectively govern HCMs. An established process for the development of CATAG Guiding Principles was undertaken to develop these Guiding Principles. This includes the formation of an Expert Advisory Group (EAG) comprising individuals with recognised expertise, development of draft principles and stakeholder consultation from within the CATAG membership and externally. All feedback was discussed, and changes were agreed upon. The final version was approved by the EAG and CATAG members. This document represents a summary of the seven Guiding Principles developed, covering the areas of governance, application and assessment, communication, training and resourcing. Although many outstanding priorities still exist, including the development of national coordination regarding HCM assessment, these Guiding Principles offer a basis to navigate this complex area.

The Individual Participant Data Integrity Tool for assessing the integrity of randomised trials.

Increasing concerns about the trustworthiness of research have prompted calls to scrutinise studies' Individual Participant Data (IPD), but guidance on how to do this was lacking. To address this, we developed the IPD Integrity Tool to screen randomised controlled trials (RCTs) for integrity issues. Development of the tool involved a literature review, consultation with an expert advisory group, piloting on two IPD meta-analyses (including 73 trials with IPD), preliminary validation on 13 datasets with and without known integrity issues, and evaluation to inform iterative refinements. The IPD Integrity Tool comprises 31 items (13 study-level, 18 IPD-specific). IPD-specific items are automated where possible, and are grouped into eight domains, including unusual data patterns, baseline characteristics, correlations, date violations, patterns of allocation, internal and external inconsistencies, and plausibility of data. Users rate each item as having either no issues, some/minor issue(s), or many/major issue(s) according to decision rules, and justification for each rating is recorded. Overall, the tool guides decision-making by determining whether a trial has no concerns, some concerns requiring further information, or major concerns warranting exclusion from evidence synthesis or publication. In our preliminary validation checks, the tool accurately identified all five studies with known integrity issues. The IPD Integrity Tool enables users to assess the integrity of RCTs via examination of IPD. The tool may be applied by evidence synthesists, editors and others to determine whether an RCT should be considered sufficiently trustworthy to contribute to the evidence base that informs policy and practice.

Designing the Australian Cancer Atlas: visualizing geostatistical model uncertainty for multiple audiences.

The Australian Cancer Atlas (ACA) aims to provide small-area estimates of cancer incidence and survival in Australia to help identify and address geographical health disparities. We report on the 21-month user-centered design study to visualize the data, in particular, the visualization of the estimate uncertainty for multiple audiences. The preliminary phases included a scoping study, literature review, and target audience focus groups. Several methods were used to reach the wide target audience. The design and development stage included digital prototyping in parallel with Bayesian model development. Feedback was sought from multiple workshops, audience focus groups, and regular meetings throughout with an expert external advisory group. The initial scoping identified 4 target audience groups: the general public, researchers, health practitioners, and policy makers. These target groups were consulted throughout the project to ensure the developed model and uncertainty visualizations were effective for communication. In this paper, we detail ACA features and design iterations, including the 3 complementary ways in which uncertainty is communicated: the wave plot, the v-plot, and color transparency. We reflect on the methods, design iterations, decision-making process, and document lessons learned for future atlases. The ACA has been hugely successful since launching in 2018. It has received over 62000 individual users from over 100 countries and across all target audiences. It has been replicated in other countries and the second version of the ACA was launched in May 2024. This paper provides rich documentation for future projects.

Electronic cigarettes and subsequent use of cigarettes in young people: An evidence and gap map.

The use of e-cigarettes may influence later smoking uptake in young people. Evidence and gap maps (EGMs) are interactive on-line tools that display the evidence and gaps in a specific area of policy or research. The aim of this study was to map clusters and gaps in evidence exploring the relationship between e-cigarette use or availability and subsequent combustible tobacco use in people aged < 30 years. We conducted an EGM of primary studies and systematic reviews. A framework and an interactive EGM was developed in consultation with an expert advisory group. A systematic search of five databases retrieved 9057 records, from which 134 studies were included. Systematic reviews were appraised using AMSTAR-2, and all included studies were coded into the EGM framework resulting in the interactive web-based EGM. A descriptive analysis of key characteristics of the identified evidence clusters and gaps resulted in this report. Studies were completed between 2015 and 2023, with the first systematic reviews being published in 2017. Most studies were conducted in western high-income countries, predominantly the United States. Cohort studies were the most frequently used study design. The evidence is clustered on e-cigarette use as an exposure, with an absolute gap identified for evidence looking into the availability of e-cigarettes and subsequent cessation of cigarette smoking. We also found little evidence analysing equity factors, and little exploring characteristics of e-cigarette devices. This evidence and gap map (EGM) offers a tool to explore the available evidence regarding the e-cigarette use/availability and later cigarette smoking in people under the age of 30 years at the time of the search. The majority of the 134 reports is from high-income countries, with an uneven geographic distribution. Most of the systematic reviews are of lower quality, suggesting the need for higher-quality reviews. The evidence is clustered around e-cigarette use as an exposure and subsequent frequency/intensity of current combustible tobacco use. Gaps in evidence focusing on e-cigarette availability, as well as on the influence of equity factors may warrant further research. This EGM can support funders and researchers in identifying future research priorities, while guiding practitioners and policymakers to the current evidence base.

Co-design workshops to develop evidence synthesis summary formats for use by clinical guideline development groups

BackgroundEvidence synthesis is used by decision-makers in various ways, such as developing evidence-based recommendations for clinical guidelines. Clinical guideline development groups (GDGs) typically discuss evidence synthesis findings in a multidisciplinary group, including patients, healthcare providers, policymakers, etc. A recent mixed methods systematic review (MMSR) identified no gold standard format for optimally presenting evidence synthesis findings to these groups. However, it provided 94 recommendations to help produce more effective summary formats for general evidence syntheses (e.g., systematic reviews). To refine the MMSR recommendations to create more actionable guidance for summary producers, we aimed to explore these 94 recommendations with participants involved in evidence synthesis and guideline development.MethodsWe conducted a descriptive qualitative study using online focus group workshops in February and March 2023. These groups used a participatory co-design approach with interactive voting activities to identify preferences for a summary format's essential content and style. We created a topic guide focused on recommendations from the MMSR with mixed methods support, ≥ 3 supporting studies, and those prioritized by an expert advisory group via a pragmatic prioritization exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Eligible participants must be/have been involved in GDGs and/or evidence synthesis. Groups were recorded and transcribed. Two independent researchers analyzed transcripts using directed content analysis with 94 pre-defined codes from the MMSR.ResultsThirty individuals participated in six focus groups. We coded 79 of the 94 pre-defined codes. Participants suggested a “less is more” structured approach that minimizes methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to further information in the full report. They emphasized concise, consistently presented formats that highlight key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the certainty of evidence (without extenuating details).ConclusionsThis study identified guidance based on the preferences of guideline developers and evidence synthesis producers about the format of evidence synthesis summaries to support decision-making. The next steps involve developing and user-testing prototype formats through one-on-one semi-structured interviews to optimize evidence synthesis summaries and support decision-making.

Guidelines for Rational Clinical Use of Fentanyl Transdermal Patch.

Pain is one of the most common clinical symptoms of cancer patients, seriously affecting the quality of life of patients and bringing heavy mental and economic burden to families and society. The treatment of cancer pain in China is facing numerous challenges, one of which includes the irrational usage of analgesic drugs in clinical practice. As a strong opioid analgesic, transdermal fentanyl patch has been widely used due to its convenient clinical application and obvious therapeutic effect. Several basic-level hospitals and even general hospitals in China fail to appropriate the application of drugs in clinical application due to the lack of understanding of the pharmacological characteristics and clinical application of fentanyl transdermal patch by medical staff, seriously affecting the treatment quality. Therefore, it is imperative to strengthen the rational use and management of fentanyl transdermal patches. Accordingly, the initiation by the Cancer Rehabilitation and Palliative Treatment Professional Committee of the Hubei Anti-cancer Association launched the compilation of the "Guidelines for Rational Clinical Use of Fentanyl Transdermal Patch" (from now on referred to as the "Guidelines") in Hubei Province, China. The experts in the preparation group are experts in many disciplines, such as medicine, pharmacy, and nursing. The expert group determines the outline, prepares the required regulations, and revises it repeatedly. Moreover, these experts put forward suggestions for revision to strictly control the accuracy and scientific authenticity of the contents of the "Guide". Finally, all experts of the preparation team certify and finalize the draft. This "Guide" prepared by experts of the Cancer Rehabilitation and Palliative Treatment Professional Committee of the Hubei Anti-cancer Association and the expert advisory group with joint efforts, aims to play a positive role in promoting the rational clinical use of fentanyl transdermal patch, reducing the mental and economic burden of patients, and ensuring medical quality and medical safety.

Development of psycho-oncology telehealth guidelines: a modified Delphi consensus study

Abstract Objective: In response to COVID-19, psycho-oncology clinicians moved to a model of telephone and videoconference treatment in Australia. The Psycho-oncology Co-operative Research Group (PoCoG) identified a paucity of evidence available to guide adaptation of therapy for remote delivery. This research aimed to develop consensus for evidence-based guidelines on ways to adapt psychological therapies in psycho-oncology for remote delivery. Methods: A national expert advisory group (N = 11) was convened consisting of psycho-oncology clinicians and clinical researchers. An iterative codesign methodology was used to draft psycho-oncology telehealth guidelines. Australian psycho-oncology clinicians participated in a Delphi consensus process to guide the content included in the guidelines. Content was presented under six domains: (i) screening and outcome measures, (ii) formulation, (iii) safety considerations, (iv) resource adaptation, (v) adaptations to therapy, and (vi) example case studies. Participants rated items based on importance, therapeutic appropriateness, and/or usefulness. Consensus was defined as &gt;80% agreement. Results: Thirty-two psycho-oncology clinicians with telehealth experience participated in three Delphi rounds. Agreement was reached on (i) the importance of including screening and outcome measures (90%) and items (n = 5) related to how best to facilitate this; (ii) the importance of addressing provision of a formulation (100%), although only 2/6 strategies presented to facilitate formulation reached consensus; (iii) the appropriateness of proposed risk assessment and management strategies (84%); (iv) therapeutic appropriateness of simplifying resources (100%), including 3/5 visual optimization strategies; and (v) common behavioral components of therapy (n=5). Conclusions: Providing guidance to psycho-oncology clinicians for integrating telehealth into routine clinical practice must go beyond logistical considerations. These consensus-based guidelines provide support to clinicians for adaptation of psycho-oncology therapy to telehealth and will ensure evidence-based practice.

현장 적용성을 고려한 수학불안 관련 수학학습 상담 및 코칭 모델(R-UTF) 개발

Recently, the 2022 curriculum included a section on math learning clinics for the personalized education, so in order to develop a program that is feasible in the field, first, responses of elementary and middle school teachers in a teacher training program using a treatment program to reduce math anxiety among the affective areas, was analyzed and a revised model was constructed, and secondly, a math learning counseling and coaching model for treating math anxiety was finally sought by re- vising the results of applying the revised model to students according to the results from the first phase. This study was a basic attempt at developing a model for field application, and the entire process was inspected using a professional council by an expert advisory group. In particular, it is expected that field applicability will be greatly increased as the results of applying the revised model to students based on the responses of teachers who participated in the teacher training were produced. As a result of the study, the advantage of literally realizing personalized education was highlighted as it is easy to diagnose and administer complex treatments in the mathematics learning process that progresses from counseling to coaching.

OP138 Navigating High-Cost Medicines: Promoting Consistent, Evidence-based Use Of High-Cost Medicines In A Fiscally And Equitable Responsible Manner

IntroductionHospitals play a significant and important role in funding high-cost medicines so patients can access treatments they need. High-cost medicines are often specialty medicines, which contribute to a significant and increasing portion of the hospital budget. It is imperative that these expensive medicines are governed and managed with a fair, standardized evidence-based process. We aim to provide a framework for Drugs and Therapeutics Committees (DTCs).MethodsDuring 2021, Guiding Principles were developed following a literature review and survey of current practices by DTCs in Australia. An Expert Advisory Group (EAG) was convened, comprising individuals with expertise in quality use of medicines, evidence-based medicine and medicines governance. The guiding principles were drafted by the EAG, in consultation with a range of stakeholders and relevant external organizations. All feedback was collated, reviewed and discussed to refine the content of the final Guiding Principles released in January 2022.ResultsSeven overarching principles provide key recommendations for the governance of high-cost medicines:(i)A definition of high‑cost medicines should be determined and clearly articulated for use by each medicines governance committee.(ii)Review of high-cost medicines requires members with relevant expertize to facilitate good and effective decision-making.(iii)The committee should engage directly with the applicant prior to review to ensure a full understanding of the rationale for the request.(iv)consistent, robust and transparent procedure for the assessment of high-cost medicine applications should be defined and implemented for use by each medicines governance committee to ensure fair process.(v)Ethical considerations fundamentally underpin deliberations around high-cost medicines.(vi)The decisions and outcomes of the decision making should be transparent and appropriately communicated to the various audiences.(vii)The high-quality assessment of high-cost medicines requires appropriate training and resourcing.ConclusionsThese national Guiding Principles promote consistent, evidence-based use of high-cost medicines and provide a framework for DTCs to assess and achieve effective governance for the quality use of high‑cost medicines.

SARS-CoV-2 transmission risk for common group activities and settings: a living scoping review.

While the modes of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are well studied, the risk of transmission in various group settings or activities is less clear. This living scoping review aims to summarize the risk factors of coronavirus disease 2019 (COVID-19) spread in common group activities (e.g. social gatherings) or settings (e.g. schools, hospitals, shared workplaces) to understand the drivers of transmission and to inform a risk assessment profile tool for use of rapid antigen detection tests. We systematically searched electronic databases, MEDLINE and Embase, from January 2019 until February 2022. We included studies that evaluated the risk of SARS-CoV-2 transmission in activities and settings, deemed strategically important to government departments in Ireland, provided by the Department of Health (Ireland) Expert Advisory Group on Rapid Testing. After screening 14 052 records, data from 139 studies were narratively synthesized. The risk was consistently reported as 'high' for large social events (e.g. weddings) and indoor sports, working in healthcare settings and shared workplaces, working/living in residential settings and travelling via public transportation. Most studies were from healthcare settings, with common risk factors including close contact with COVID-19 cases, working in high-risk departments and inappropriate use of personal protective equipment. For other settings and activities, lack of infection prevention and control practices reportedly contributed to infection transmission. The heterogeneity across studies and lack of direct information on dominant variants, preventive measures, vaccination coverage necessitates further research on transmission risk within group activities to inform infection prevention and control measures.

Lessons learnt from the COVID-19 pandemic in selected countries to inform strengthening of public health systems: a qualitative study

IntroductionThe COVID-19 pandemic has prompted governments internationally to consider strengthening their public health systems. To support the work of Ireland's Public Health Reform Expert Advisory Group, the Health Information and Quality Authority, an independent governmental agency, was asked to describe the lessons learnt regarding the public health response to COVID-19 internationally and the applicability of this response for future pandemic preparedness. MethodsSemi-structured interviews with key public health representatives from nine countries were conducted. Interviews were conducted in March and April 2022 remotely via Zoom and were recorded. Notes were taken by two researchers, and a thematic analysis undertaken. ResultsLessons learnt from the COVID-19 pandemic related to three main themes: 1) setting policy; 2) delivering public health interventions; and 3) providing effective communication. Real-time surveillance, evidence synthesis, and cross-sectoral collaboration were reported as essential for policy setting; it was noted that having these functions established prior to the pandemic would lead to a more efficient implementation in a health emergency. Delivering public health interventions such as testing, contact tracing, and vaccination were key to limiting and or mitigating the spread of the SARS-CoV-2 virus. However, a number of challenges were highlighted such as staff capacity and burnout, delays in vaccination procurement, and reduced delivery of regular healthcare services. Clear, consistent, and regular communication of the scientific evidence was key to engaging citizens with mitigation strategies. However, these communication strategies had to compete with an infodemic of information being circulated, particularly through social media. ConclusionsOverall, functions relating to policy setting, public health interventions, and communication are key to pandemic response. Ideally, these should be established in the preparedness phase so that they can be rapidly scaled-up during a pandemic.

Experiences of health service access: A qualitative interview study of people living with Parkinson's disease in Ireland.

People with Parkinson's disease (PD) do not always access specialist outpatient services in a timely manner in Ireland. The perspectives of people living with PD, relating to service access, are largely absent in the existing literature. To explore experiences of PD service access for people living with PD, using a qualitative approach. Purposive maximum variation sampling was used. Semi-structured telephone interviews were conducted with 25 service users, including people with PD (n = 22) and supporting carers (n = 3). Informed consent was obtained from all participants. Interviews ranged in duration from 30 to 90 min. Data were managed in NVivo 12 and interpreted inductively using thematic analysis. The researchers were reflexive throughout the research process. The Consolidated Criteria for Reporting Qualitative Research checklist was employed to maximise transparency. The findings highlight several key barriers to and facilitators of equitable and timely service access. Three key themes were identified comprising experiences of PD service access including 'geographical inequity', 'discriminatory practices', and 'public and private system deficits'. Together, these themes illustrate how a two-tiered and under-resourced health system lacks capacity, in terms of infrastructure and workforce, to meet PD needs for both public and private patients in Ireland. These findings point to problems for PD care, relating to (i) how the health system is structured, (ii) the under-provision and under-resourcing of specialist outpatient PD services, including medical, nursing, and multidisciplinary posts, and (iii) insufficient PD awareness education and training across health settings. The findings also show that telemedicine can provide opportunities for making access to certain aspects of PD care more flexible and equitable, but the feasibility and acceptability of technology-enabled care must be assessed on an individual basis. Implications for policy, practice and research are discussed. The design and conduct of this study were supported by an expert advisory group (EAG) of 10 co-researchers living with PD. The EAG reviewed the interview schedule and the protocol for this study and provided detailed feedback from their perspective, to improve the methods, including the interview approach. The group also reviewed the findings of the study and contributed their insights on the meaning of the findings, which fed into this paper.

Co-designing a community lifestyle intervention program to reduce postpartum weight retention.

Postpartum weight retention is a major contributor to obesity in later life resulting in long-term health consequences in women. Postpartum lifestyle interventions are known to be effective in reducing postpartum weight retention and improving the overall health and wellbeing of mothers but have poor reach and engagement. This study describes the engagement of mothers with young children in the development of a theory- and evidence-based intervention to reduce postpartum weight retention. A participatory design methodology with input from a community mothers'group, literature reviewsand an expert advisory group was applied. Mothers who were members of 'Mothers of Preschoolers' (MOPS) were invited to participate in a focus group discussion and two co-design workshop sessions. Thirteen women participated in a focus group discussion and 12 women in each co-design workshop. We found that mothers valued having social support from their peers, practical support such as meal delivery, and learning opportunities that focus on the mother's health and wellbeing. The advisory group suggested leveraging the unique skills and prior experiences of mothers within the group and developing a curriculum that mothers can be trained to deliver. A program that emphasizes the strengths and value of mothers can increase their self-worth and self-confidence resulting in intrinsic motivation to improve lifestyle behaviours. An intervention designed to be implemented by MOPS for its members and incorporated into their regular sessions has the potential for feasibility and acceptability among mothers with young children. Mothers with young children were part of the program planners and were involved in the design and conduct of this study and in the interpretation of the findings. A member of a community mothers'group recruited other mothers with young children within the group to participate in a series of sessions to discuss their experiences of the postpartum period and preferences for a lifestyle program. The mothers identified the behavioural outcomes and program goals for a postpartum lifestyle program and then generated the program ideas based on these.

Communicating evidence synthesis: co-designing summary formats with end users

Abstract Background Evidence syntheses are essential to the creation of evidence-based guidelines that guide health care. Findings from our recent mixed methods systematic review (MMSR) identified no gold standard format for communicating summaries of evidence syntheses to guideline development groups. This is important as these groups are comprised of patients, healthcare providers, policymakers, etc., who all have different expertise, perspectives and priorities. Our overall aim is to develop evidence-informed prototype summary formats for use in guideline development. To inform this process, we held online co-design focus group workshops shaped by findings from our MMSR. Methods We held six focus groups with 30 participants involved in developing guidelines and/or evidence synthesis (February - March 2023). The topic guide was informed by the MMSR -- focusing on recommendations with mixed methods support, ≥3 supporting studies, and those prioritised by an expert advisory group through a pragmatic prioritisation exercise using the MoSCoW method (Must, Should, Could, and Will not haves). Focus groups were recorded and transcripts were analysed using a directed content analysis. Results Participants suggested a “less-is-more” structured approach that minimises methodological steps and statistical data, promoting accessibility to all audiences by judicious use of links to the full technical report. They emphasized the importance of concise consistently-presented formats which emphasize key messages, flag readers to indicators of trust in the producers (i.e., logos, websites, and conflict of interest statements), and highlight the quality of evidence. Conclusions Project findings are informing the creation of accessible and actionable guidance on best-practices for creating summary formats. Next steps involve user-testing prototype formats through semi-structured interviews which will then be integrated into the National Clinical Guideline development process in Ireland. Key messages • Co-design workshops delineated key aspects of effective and acceptable evidence synthesis summary formats to help create reproducible format templates for use in clinical guideline development. • Creating summary formats accessible to all guideline development group members will promote better communication and translation of research evidence into recommendations and practice.

Establishing a Platform for Public Health Advocacy in the midst of a Pandemic

Abstract Issue/problem Prior to the COVID-19 pandemic, Doctors working in Public Health Medicine in Ireland lacked a platform to present a collective voice to advocate on issues of public health concern. The aim of this abstract is to describe the establishment of a platform for advocacy through the formation of the Irish Society of Specialists in Public Health Medicine (ISSPHM). Description of the problem An independent society for Public Health Doctors in Ireland was lacking. Models used by other medical specialties in Ireland and international practice was reviewed. The ISSPHM was developed to build capacity and capability for advocacy amongst Public Health Doctors in Ireland by providing indemnity for members and a forum to interact with the media. Results A constitution, mission statement and website for the society were developed. The formal launch of the ISSPHM took place in December 2021. Outputs to date include co-hosting of webinar entitled ‘Public Health and the Law'; contributing to the Irish Public Health Reform Expert Advisory Group; a position paper on pandemic preparedness; a statement on migrant health (published on the ISSPHM website and widely quoted in the media); letters published in Irish media; interviews on national radio and the formation of a Climate Change Working Group. Lessons The ISSPHM successfully creates an environment where Public Health Doctors can advocate on major issues. The establishment of an independent society requires diverse expertise and resources. Future plans for the ISSPHM are to further collaborate and build on existing partnerships and expand eligibility for membership to include other colleagues working in Public Health e.g. nurses, surveillance scientists, data analysts. Key messages • An independent national society for Public Health Doctors is an extremely useful vehicle for advocacy. • The establishment and development of an independent society is a significant undertaking requiring diverse expertise.

Assessing knowledge, attitude, practices and vaccine hesitancy in nurses: a pilot study

Abstract Background The use of a validated and reliable tool to assess knowledge, attitude, practices (KAP) and vaccine hesitancy (VH) in nurses is critical to developing tailored public health strategies to implement adherence to recommended vaccines for healthcare workers (HCWs) and reduce the chance of spreading vaccine-preventable diseases. The aim of this study is to develop and validate a tool to assess nurses’ vaccine hesitancy and KAP regarding recommended vaccines for HCWs. Methods Following a systematic review of the literature (PROSPERO ID:CRD42020212252), a new tool was built to assess vaccine hesitancy using the framework of the WHO Strategic Expert Advisory Group on Immunization. The pilot study collected responses from a random sample of nurses and nursing students. The content validity (including face-validity) was evaluated with a panel of experts. Internal reliability was tested using Cronbach's alpha (α). Results The final questionnaire consisted of three sections and forty items. A total of 124 individuals, 40 nurses and 84 nursing students were enrolled. Regarding KAP: only ten nurses (26.3%) reported adequate knowledge of recommended vaccines for HCWs, while no students reported knowing the vaccines included in the recommendations. 40% of nurses and 63% of nursing students discuss safety and efficacy of vaccinations during clinical practice. Twelve (32%) nurses and 42 (50%) students reported VH for at least one of the recommended vaccines for HCWs, with particular regard to flu vaccination and COVID-19 vaccine for which, despite being vaccinated, half of nurses and students reported concerns mainly about efficacy and safety. The reliability of vaccine hesitancy scales in nurses (α = 0.82) and nursing students (α = 0.85) could be considered good. Conclusions Following the validation of this tool, a multicenter cross-sectional study will be conducted involving three universities (Sapienza, Bicocca, Turin) on a national sample of nurses and nursing students. Key messages • Systematically measuring vaccine hesitancy in at-risk populations with a nationally validated tool enables implementation of targeted public health strategies. • Identifying nurses’ knowledge, attitudes, and practices regarding vaccination and vaccine hesitancy enables organizations to adequately address the training needs of their health workers.