Local Health Services Research Articles

Trend of Corporate Social Responsibility Spending by Public Sector Organisations: Evidence from Water Supply and Sanitation Authority in Tanzania

Background: Corporate Social Responsibility (CSR) has gained prominence as organisations increasingly recognise their role in contributing to social and environmental well-being. This study focuses on the CSR spending trends of Public Water Supply and Sanitation Authorities (WSSAs) in Tanzania, shedding light on their commitment to sustainable development through social and environmental initiatives. Objective: The study aim was to assess the trends of CSR spending by WSSAs in Tanzania over a five-year period (2015-2019). Specifically, the study aims to identify areas of CSR investment and assess the distribution of financial resources among various CSR activities undertaken by WSSAs. Method: Secondary data from 114 WSSAs were analysed using descriptive methods, specifically the line graphs to show CSR spending trends, and paired t-tests gauged significant changes over the five years. Results: The study finding reveals a gradual increase in CSR spending by WSSAs in Tanzania from 2015 to 2019. This upward trend indicates a sustained dedication to fulfil social and environmental responsibilities, contributing to the broader goal of sustainable development. The study also indicates a preference for directing CSR resources towards social-oriented activities. Notably, the highest spending was observed in local educational programmes and health services, while the lowest spending was observed on sports and cultural festivals. Conclusion: The study emphasises fostering policies to encourage ongoing CSR spending by WSSAs, especially in impactful education and health areas. Collaborative frameworks with local communities can address social and environmental challenges, aligning initiatives with community needs for holistic regional development. Keywords: Corporate social responsibility spending, Public sector organisations, Tanzania

Support, not blame: safe partner disclosure among women diagnosed with HIV late in pregnancy in South Africa and Uganda

BackgroundHIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure.MethodsWe conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software.ResultsOur findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby’s safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the ‘right’ time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure.ConclusionHIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health.

User perspectives on the role of local services in promoting labor market participation of people with chronic illnesses

How do local Norwegian work, welfare, and health services (WWH services) support the labor market integration of chronically ill people? We discuss how user organization representatives evaluate the role of municipal-level service support in facilitating labor market participation of people with chronic illnesses and disabilities, and to what extent the views of user organizations are requested and included in local service development. We thus contribute to the limited research on the role of WWH services for work inclusion from the user perspective. Our analysis rests on an original web-based survey, combining qualitative and quantitative data, and a focus group discussion. Although user representatives call for strengthening of services, they also view employers’ adaptations as being more important than local services. And despite their expertise, user organizations are only included in local service development to a limited extent.

Local Health Service Response to COVID-19 in Mexico: Notes From an Exploratory Qualitative Study.

The main goal of a health system is to maintain or improve people's health. The COVID-19 pandemic showed the fragility of health systems worldwide. In Mexico, the pandemic affected the performance of the health system, along with the presence of contextual conditions such as its segmentation and high prevalence of chronic diseases. To analyze from an approach to the functions of the health system, the service delivery, human resources, financing, and stewardship/governance in the local health services of five states of Mexico, from the perspective of the staff working in health centers. This is an exploratory qualitative study conducted from November 2020 to August 2021, involving 124 health professionals from 39 health facilities (18 rural and 21 urban). The technique used was the semi-structured interview. Interview guides were developed according to core topics. Subsequently, the thematic analysis method was used. The lack of financial resources delayed prevention efforts and made it difficult for health centers to adapt to the crisis. Inequity was found in the distributive efficiency of staff between rural and urban areas and levels of care. In addition, there was evidence of capacity for coordination, capacity sharing, and joint participation between health institutions, civil authorities, and the population to face the emergency. We identified relevant public health actions that showed the capacity of local health services to organize a response to the pandemic at the level of the actors responsible for these services.

An assessment of ten popular pregnancy applications (Apps) available for women in Australia

ObjectiveGiven the growing popularity of health Apps, this study aimed to evaluate popular pregnancy Apps among Australian women. DesignTen popular pregnancy mobile device Apps accessible within Australia were assessed using the Deakin Health E-technologies Assessment Lab (HEAL) framework, the Australian Privacy Principles (APP) and other context-specific criteria. ResultsMost Apps were robust in use and user-friendly in terms of design. Based on the HEAL assessment, all the Apps scored between 70 and 89 out of 120. Only two of the ten Apps were locally hosted and operated. Only one App could search local health services using Victorian postcodes. All ten Apps were aligned with various privacy policy guidelines, but only one was reported to be fully aligned with the APP as it is locally hosted and operated. None of the Apps had accessibility features such as for visual or hearing difficulties. Only one App could be assessed as able to interface with the electronic medical record system in Australia due to a lack of publicly available information on this capability. ConclusionsDue to privacy concerns, pregnancy Apps accessible in Australia should be used with caution unless care is taken to select an App that fully complies with local requirements or international equivalents. All Apps were subjectively rated as moderate in quality, and more attention to accessibility and privacy features by App developers is recommended, along with the focus on integration with Australian digital health services.

From a Single Voice to Diversity: Reframing 'Representation' in Patient Engagement.

There has been a growing emphasis on consumer representation in the development of health policy, services, research, and education. Existing literature has critiqued how discourses of representativeness can disempower consumers working in health systems. The context of the current study is consumer engagement in the development of COVID-19 triage policy and practice in a local health service. Consumer engagement has often been an afterthought in the COVID response, with few examples of consumers in agenda-setting or decision-making roles. In the Australian Capital Territory, 26 consumer, carer, and community groups worked together with academics and clinicians to develop these principles. Interviews were conducted with stakeholders (including consumers, clinicians, and other health professionals) to evaluate the development of triage principles. A discursive psychological approach to analysis was used to explore participants' understandings about and constructions of consumers being representative (or not) and how this may reproduce power imbalances against consumers. The results explore two distinct ways in which participants talked about consumer representativeness: the first drawing on rhetoric about consumers as lay members of the public (as distinct from being professionally engaged in the health sector), and the second in terms of consumer representatives being diverse and having intersectional identities and experiences. Expectations about consumers to be representative of the general population may reproduce traditional power imbalances and silence lived experience expertise. These power imbalances may be challenged by a shift in the way representativeness is conceptualised to requiring health services to seek out diverse and intersectionally marginalised consumers.

Piloting a narrative‐mantra multi‐clinician group for mental health clinicians at a child and adolescent mental health service in London, UK

AbstractThis study presents a mixed‐methodology pilot study of a narrative‐mantra multi‐clinician group, which is an integrative systemic and mindfulness‐based intervention, to promote the well‐being of mental health clinicians working at a local child and adolescent mental health service in London, UK. The study also served as a nonclinical sample pilot for a narrative‐mantra multi‐family group trial for adolescents awaiting treatment and their parents. In total, nine clinicians participated in the study: five participants and four controls. Descriptive analyses were conducted on self‐reported measures, GHQ‐12 and SCORE‐15. Slight improvements were found in the clinicians' mental well‐being and their significant relationships. Five global themes emerged from the thematic analysis of a focus group discussion, including ‘voices that connect and liberate’ and ‘connecting ingredients for integration’.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Practitioner psychologists' perspectives on working with clients with psychosis in a South‐East Asian city‐state: A qualitative investigation

AbstractObjectivePrevious qualitative studies have investigated the experiences of undergoing an evidence‐based psychotherapy for psychosis among individuals affected by such condition. However, the literature investigating the perspectives, experiences and needs of psychological practitioners providing the treatment remains considerably underrepresented. In the context of Asian cultures, where pervasive stigma towards psychosis and mental health services exists and interferes with proactive help‐seeking, such research appears even more pertinent. To address the gap in the existing literature, this study utilised qualitative methodology to investigate the experiences of practitioner psychologists working with clients with psychosis in a South‐East Asian city‐state.MethodSix fully qualified participants were recruited from the local mental health services via convenience sampling. Semi‐structured qualitative interviews were conducted. Transcribed verbatim data were then subjected to inductive thematic analysis.ResultsFour superordinate themes emerged, as follows: therapeutic alliance, cognitive behavioural therapy for psychosis (CBTp) as primary approach, cultural influences and needs of practitioners.ConclusionsResults indicated that both practitioner psychologists and their clients contributed collaboratively to the establishment of therapeutic alliance. Although CBTp was utilised as a principal psychotherapeutic approach, acceptance and commitment therapy (ACT) was also valued. Necessary adaptations in the treatment were reflected on to address the specificity of local cultures, including the use of language and addressing pervasive public stigma. The necessity of multidisciplinary collaboration, localised training and supervision was also expressed.

Online public health promotion at the local level: An evaluation of four local authority-led marketing campaigns.

Local authority-led online campaigns offer the possibility of targeted health promotion to connect local services and residents. This study assesses the evidence for medium (e.g., click-trhoughs) and high (off-line behaviour change) levels of public engagement with four local authority-led campaigns across a variety of public health promotions (sexual health, weight loss, and vaccination), online marketing approaches (social media marketing, search engine marketing, and programmatic marketing) and target demographics (language, gender, age, income, ethnicity) undertaken by a London borough local authority. Employing quasi-experimental and observational study designs, engagement with local health services during the course of the campaigns was evaluated. The first three campaigns were evaluated based on an interrupted time series model of intervention assessment comparing outcome variables of interest during the campaign to periods before and after the campaign period. The results of the fourth campaign, an observational case-study, are discussed using descriptive statistics only. The analyses of the high engagement data for two of the three campaigns statistically assessed clearly supported the effectiveness of the campaigns. While the effect of high engagement could not be determined in the other two campaigns, they provide data that may be useful in online campaign design. The evidence assessed in this study across a variety of platforms, health promotion initiatives, and population targets suggests that local authority-led online marketing campaigns for health promotion may be useful for increasing participation in public health programmes.

Barriers and facilitators for the sexual and reproductive health and rights of displaced Venezuelan adolescent girls in Brazil

BackgroundThe crisis in Venezuela has forced almost eight million people to flee to mainly neighbouring countries, including Brazil. Half of the displaced Venezuelans are women and girls, with adolescent girls facing distinctive challenges to their sexual and reproductive health during displacement and settlement. The aim of this study is to understand the barriers and facilitators for the sexual and reproductive health of adolescent Venezuelan girls residing in Brazil. MethodsThe study used qualitative methods, including semi-structured interviews with 19 Venezuelan migrant adolescent girls conducted in Boa Vista and Manaus. We analysed transcripts using thematic analysis, and mapped findings to a theoretical framework based on the Bronfenbrenner Socio-ecological Model, which we adapted to explore how intersectional vulnerabilities at the individual level interact with contextual factors creating barriers and facilitators for health and rights of migrant adolescent girls. ResultsVenezuelan adolescent migrants in Brazil face practical and structural barriers in realising their sexual and reproductive health and rights in four areas: menstruation; family planning, contraception and sexually transmitted infection; prenatal, childbirth and postnatal care; and preventing gender-based violence. The reported barriers were lack of knowledge around sexual and reproductive health rights, exposure to violence and lack of access to age-appropriate healthcare services. Mitigating factors included education (both in the family setting and at school); prevention activities undertaken by health services; care provision from non-governmental organisations and international agencies; and best practices in local health services. ConclusionsHost states must take action to enhance the right to sexual and reproductive health for adolescent migrants to allow them to make autonomous, independent and informed choices. A socioecological perspective on sexual and reproductive health and rights can help formulate intersectional policies that interconnect different levels of adolescent migrants’ experience.

Using Expert Elicitation to Adjust Published Intervention Effects to Reflect the Local Context.

Local health services make limited use of economic evaluation to inform their decisions on the funding of new health service interventions. One barrier to use is the relevance of published intervention evaluations to the local setting.Expert elicitation methods provide a structured way to consider differences between the evaluation and local settings and to explicitly and transparently adjust published effect estimates for use in local economic evaluations.The pragmatic elicitation methods reported in this article offer a feasible and acceptable approach to adjusting published intervention effects to better reflect the effects expected in the local context. This increases the relevance of economic evaluations for local decision makers.

Perceptions of Learners and Specialists Toward ECHO Palliative Care Project in Thailand.

The Extension of Community Health Outcomes (ECHO) is a global movement that aims to decentralize the knowledge of specialists to primary care. A pilot, ECHO palliative care project in Thailand, was introduced to enhance the implementation of palliative care practice. To assess learners' and palliative care specialists' perceptions toward the ECHO palliative care project to improve and expand the project in the future. A total of 15 hospitals in 7 provinces in Northern Thailand, including provincial and district hospitals. A qualitative study was conducted among learners (primary care providers) and palliative care specialists who participated in the pilot program. Semi-structured interviews were used to explore the potential impact of the project on clinical practice, the strengths and weaknesses of the ECHO program and platform in the Thai context, and suggestions for expansion. Thematic analysis was used for qualitative analysis. Pre- and post-confidence scores, using a 5-point Likert Scale, for palliative care practice among learners were analyzed using paired T-tests. Twenty participants were interviewed: 15 learners and 5 palliative care specialists. The confidence in practicing palliative care after participating in the ECHO palliative care project significantly increased for the learners, from 2.93 (95% CI, 2.49-3.38) to 3.93 (95% CI, 3.68-4.19) points (P = .003). Three themes emerged through the process evaluation of the pilot ECHO palliative care project: (1) applicable lessons that can translate to practice, (2) an effective learning program and assessable platform, and (3) suggestions for expansion. The ECHO palliative care project increased confidence in providing palliative care for primary care providers in Thailand. Through capacity building, participants reported applying the knowledge to improve local health services and develop a network for consultations and referrals. There is potential for expansion of the ECHO palliative care project in Thailand.

Estimating immunization coverage at the district level: A case study of measles and diphtheria-pertussis-tetanus-Hib-HepB vaccines in Ethiopia.

Ethiopia has made significant progress in the last two decades in improving the availability and coverage of essential maternal and child health services including childhood immunizations. As Ethiopia keeps momentum towards achieving national immunization goals, methods must be developed to analyze routinely collected health facility data and generate localized coverage estimates. This study leverages the District Health Information Software (DHIS2) platform to estimate immunization coverage for the first dose of measles vaccine (MCV1) and the third dose of diphtheria-pertussis-tetanus-Hib-HepB vaccine (Penta3) across Ethiopian districts ("woredas"). Monthly reported numbers of administered MCV1 and Penta3 immunizations were extracted from public facilities from DHIS2 for 2017/2018-2021/2022 and corrected for quality based on completeness and consistency across time and districts. We then utilized three sources for the target population (infants) to compute administrative coverage estimates: Central Statistical Agency, DHIS2, and WorldPop. The Ethiopian Demographic and Health Surveys were used as benchmarks to which administrative estimates were adjusted at the regional level. Administrative vaccine coverage was estimated for all woredas, and, after adjustments, was bounded within 0-100%. In regions with the highest immunization coverage, MCV1 coverage would range from 83 to 100% and Penta3 coverage from 88 to 100% (Addis Ababa, 2021/2022); MCV1 from 8 to 100% and Penta3 from 4 to 100% (Tigray, 2019/2020). Nationally, the Gini index for MCV1 was 0.37, from 0.13 (Harari) to 0.37 (Somali); for Penta3, it was 0.36, from 0.16 (Harari) to 0.36 (Somali). The use of routine health information systems, such as DHIS2, combined with household surveys permits the generation of local health services coverage estimates. This enables the design of tailored health policies with the capacity to measure progress towards achieving national targets, especially in terms of inequality reductions.

Healthy Age Friendly Homes Programme: Evaluation of a Multi Stakeholder Intervention to Ageing in Place

Introduction: Healthy Age Friendly Homes (HAFH) Phase 1 Pilot is a pilot programme aimed at creating a service to identify older people living at home and supporting them to age in place. It is a multi-stakeholder project, evaluated by Maynooth University and funded by Sláintecare, with the programme being delivered by Age Friendly Ireland hosted by Meath County Council. 
 There were 768,900 persons living in Ireland aged 65 and over in April 2022, an increase of 139,100 older people since 2016. With an increasing population of older people; increased supports and services are required to adapt to this change. The aim of this programme was to take a multi-pronged approach encompassing health, housing, community and social supports, and technology, to support older people to remain independent at home, for as long as possible. 
 Recruitment: A sample of convenience was sought across 9 counties. A National Manager and 9 Local Co-ordinators were appointed by Age Friendly Ireland, who conducted a series of awareness campaigns to encourage older people to self-refer into the programme. In addition, a multi stakeholder recruitment approach was utilised, working with services such as personnel in local government, health services, transport, community and voluntary groups, Gardaí, elected members and others, to identify those in communities who may benefit from the programme. 
 Methods: Participants received a home visit from one of 9 Local Co-ordinators who conducted a personal assessment with each individual, covering the four key domains of health, housing, community/social and technology needs. Work orders were prepared based on individual needs assessments including referral to services such as befriending teams, health practitioners and assistance with completion of documentation relating to housing grants, and other opportunities available to older people such as rightsizing. 
 Consenting research participants received two phone calls, at the beginning of the intervention and at 6 months post intervention. Data was collected on; Health Status (EQ-5D), Social Supports - The Oslo Social Support Scale (OSSS-3), Quality of Life - The CASP-12, Loneliness - The UCLA and on Self-Efficacy - The GSE scale. A randomised sample was chosen from each geographical region to undertake a qualitative interview, recording perceptions of the programme. The topic guide was created in line with the RE-AIM framework for intervention studies. 
 Results: To date, 169 participants have taken part in the research evaluation presented. At baseline, 23% reported that their house does not meet their needs. Less than one quarter (24%) had previously applied for a housing adaptation grant. 21% of participants reported moderate problems with mobility, 25% reported moderate problems with pain/discomfort, and 16% reported slight problems with anxiety or depression. 18% of participants reported poor social support and a mean score of 27.24 was reported on the CASP-12. The programme was positively received by participants; one of the most positive aspects reported was the social interaction gained. 
 Conclusion: The HAFH programme has been well received by participants and demonstrates how partnerships between local government, community and health services, can positively enhance the lives of older people living in the community.

Physical Activity on Referral in Brussels

Since 2017, Huis voor Gezondheid has been coordinating the Physical Activity On Referral project in Brussels with the approval of the Flemish Government. The aim of this project is that doctors motivate their patients to adopt a more active lifestyle and that people from Brussels move more. If the patient is sufficiently motivated, the doctor can refer this patient to the Physical activity on referral-coach via a referral letter. The coach motivates and supports the patient on their way to a more active lifestyle. He does this through motivational interviewing and by sounding out which low-threshold exercise initiatives the patient wants to integrate into his daily life.
 In principle, every inhabitant of the Brussels-Capital Region can be referred to the coach. The project is mainly intended for people with an inactive lifestyle and for people with certain health risks or health problems for which exercise has already been shown to have a positive influence. Children cannot be referred, interested persons must be at least 18 years old.
 The project pays attention to the vulnerable population by mapping the local low-threshold exercise offer and by providing lower rates for people with an increased allowance for the coach. In Brussels especially this group is important to include and to pay extra attention to.
 In short, this project focuses on prevention, on keeping people healthy for as long as possible through integrated care.
 Scope of the project: The project currently is active in 4 municipalities in Brussels: Anderlecht, Sint-Jans-Molenbeek, Schaarbeek and Brussels-city.
 Partners: Physical Activity On Referral starts from a local intersectoral network in which local and regional partners from different sectors are represented such as local authorities, doctors, health and welfare services, providers of low-threshold exercise options, organizations that reach vulnerable groups,…. Each municipality consists of an intersectoral network. These regional partners are crucial for the succes of the project. Without all these partners, we would not be able te reach as many citizens as we do now.
 The interventions: Every year, Huis voor Gezondheid organizes several intersectoral local antennas within each municipality to discuss the progress of the project. In addition, Huis voor Gezondheid is also organizing a major event to bring all partners together of the project.
 Results: Since 2017 to the end of 2021 we have reached a total of 464 patients
 
 2017: 14 patients
 2018: 115 patients
 2019: 154 patients
 2020: 85 patients
 2021: 96 patiënts
 
 Learnings and next steps: The evaluations of patients and doctors show that patients move more after following a trajectory with the coach. In 2023 we will implement the project within the municipality of Jette.

Penyuluhan Tentang Pencegahan Stunting Pada Remaja Di SMK N 1 Batang Toru

Stunting is a nutritional problem that threatens the quality of life of the nation's future generations. The complexity of the stunting problem, which is a link in the chain, starts from parents' initial education regarding the importance of knowledge about stunting. The importance of knowledge about stunting from adolescence in order to prevent the birth of babies with nutritional problems which cause the growth of toddlers with stunting. Education about the stunting rate in Aek Ngadol Village, Batang Toru District and the absence of socialization by health workers regarding the prevention of stunting from adolescence. In this socialization, an assessment of knowledge about stunting was carried out using the counseling method for students, outreach activities and discussion of material regarding stunting and the first 1000 days of life in adolescents, as well as an assessment of students' knowledge after the counseling was carried out with a question and answer session regarding the material presented. The results of this activity providing questions and answers showed that there had been an increase in students' knowledge about stunting and the first 1000 days of life. Seeing the enthusiasm of students and the importance of efforts to prevent stunting from adolescence with education about stunting and the first 1000 days of life and it is recommended that this outreach be carried out by health workers from local health service facilities periodically to all students so that it can reach all teenagers in Aek Ngadol Village, District Batang Toru, South Tapanuli Regency. Keywords : Education, Demonstration, Stunting

The Benefits of Cooperative Inquiry in Health Services Research: Lessons from an Australian Aboriginal and Torres Strait Islander Health Study.

Health services research is underpinned by partnerships between researchers and health services. Partnership-based research is increasingly needed to deal with the uncertainty of global pandemics, climate change induced severe weather events, and other disruptions. To date there is very little data on what has happened to health services research during the COVID-19 pandemic. This paper describes the establishment of an Australian multistate Decolonising Practice research project and charts its adaptation in the face of disruptions. The project used cooperative inquiry method, where partner health services contribute as coresearchers. When the COVID-19 pandemic hit, data collection needed to be immediately paused, and when restrictions started to lift, all research plans had to be renegotiated with services. Adapting the research surfaced health service, university, and staffing considerations. Our experience suggests that cooperative inquiry was invaluable in successfully navigating this uncertainty and negotiating the continuance of the research. Flexible, participatory methods such as cooperative inquiry will continue to be vital for successful health services research predicated on partnerships between researchers and health services into the future. They are also crucial for understanding local context and health services priorities and ways of working, and for decolonising Indigenous health research.

Epidemiology of head and neck cancer in a Johannesburg Hospital: A file review

Background: There is little to no epidemiological data on the presentation of head and neck cancer (HNC) patients in South Africa. These data are important to ensure that local teaching, research and health services meet the needs of this population.Aim: To describe the epidemiological data of HNC patients using a record review from a tertiary level hospital in Johannesburg, South Africa.Setting: This study was piloted in a tertiary public hospital in Gauteng, South Africa.Methods: Sixty files between 2015 and 2021 were analysed quantitatively to describe the trends of HNC patients presenting to the hospital. This was a pilot study to review if this methodology can be used for future larger scale studies in South Africa.Results: Missing data were a significant finding as well as a limitation of the study. The most common form of HNC was laryngeal cancer, and African males were the predominant demographic. The most common comorbidities were smoking, hypertension and HIV/AIDS. The majority of patients presented with speech and swallowing difficulties and various complications that required multidisciplinary team management.Conclusion: All HNC patients need to undergo early screening to assess for speech and swallowing difficulties to prevent further complications.Contribution: The data derived from this study are novel and specific to the South African population. More studies of this nature are required to increase the availability of epidemiological data for this population, in order to inform evidence-based practices.

Equity and local health systems: a qualitative evaluation of the experiences of local health service leads during the first two years of the NHS Low Calorie Diet programme pilot

Background: Obesity and type 2 diabetes (T2DM) can both profoundly impact health and wellbeing. Their prevalence largely follows a social gradient. The National Health Service Low Calorie Diet programme in England aims to support people to achieve T2DM remission while also reducing health inequalities. We aimed to explore the experiences of local health service leads and identify barriers and facilitators in relation to the equitable mobilisation of the Low Calorie Diet programme. Methods: Twenty semi-structured interviews were completed with 24 locality leads across the first two years of the Low Calorie Diet programme. Interviewees were purposively sampled from the 10 localities who undertook the Low Calorie Diet programme pilot. Each interview explored a number of topics of interest, including referrals, training, communication, incentivisation, governance and engagement, before being subjected to a thematic analysis. Results: From the data, seven core themes were identified: COVID-19 and primary care capacity and engagement; methods of communication; approaches to training; approaches to incentivisation; approaches to referrals; barriers to referrals; and the importance of collaboration. COVID-19 presented a specific challenge to the mobilisation and delivery of the Low Calorie Diet programme; however, our findings demonstrate the large variation and differences in the approaches taken when delivering the programme across 10 geographically and demographically distinct pilot sites. We also identified a lack of a recognised approach or strategy to mobilisation and delivery support for the Low Calorie Diet programme, such as proportionate universalism, which is a social policy response to tackling health inequalities by ensuring that service delivery is equitable. Conclusions: Health inequalities remain a significant challenge, and health service leads have the potential to adopt an equity perspective from the start of programme mobilisation. In doing so, resources at their disposal can be managed equitably and can therefore contribute to efforts to reduce the potential occurrence of intervention-generated inequalities.