Strategic Research and Development

• a significant reduction in the time to first fall in the intervention group compared to the control group at the end of the study period (2 months after the intervention classes end);
• a significant reduction in the average number of falls in the intervention group compared to the control group at the end of the study period;
• a significant improvement in balance in the intervention group compared to the control group at the end of the intervention period (that is, at the end of the intervention classes); and
• a significant reduction in the fear of falling and increase in functionality in the intervention group compared to the control group at the end of the intervention period.

Preventing falls in older people is a public health priority. Not only do falls incur a major cost to the health system but they adversely affect the quality of life of older people and increase the risk of premature death.

The Central Sydney Tai Chi Trial was a randomised control trial investigating the effectiveness of an introductory tai chi program in reducing the risk of falling among community-dwelling people aged 60 years or over. Eligible participants were randomised into either a control group (n = 347) or an intervention group (n = 355) for 6 months.

The intervention consisted of a one-hour tai chi class per week for 16 weeks. The main outcome variable was falls recorded concurrently throughout the 6-month trial period.
Intermediate outcome variables were: balance, leg strength, ankle flexibility, daily functioning, and fear of falling. These were measured at baseline and again at the conclusion of the intervention tai chi classes.

Results indicate that an introductory 16-week tai chi program reduces the risk of falling by 35 per cent in people aged 60 years and over living independently in the community. The 16-week program also improves aspects of balance, although the exact relationship between balance and falls is not clear.

The trial showed that a relatively simple community-based program of an introductory tai chi consisting of a one-hour class per week reduces the risk of falling by 35 per cent in people aged 60 years and over living independently in the community

1. To determine if the use of Personal Hearing Protection (PHP) by farmers has changed since being exposed to the program;
2. To determine if farmers engaged in any of the specific recommendations made to them as a result of their hearing tests;
3. To determine if there are any characteristics that relate to a change in the use of PHP (eg age, gender, commodity, hearing level, etc);
4. To determine if there are any farmer characteristics that relate to engagement with the recommendations made to them as a result of hearing tests; and
5. To determine if the farmers exposed to the program found the program of value.

The New South Wales Rural Hearing Conservation Program is a hearing screening and education program for farmers and farm workers, which is provided at agricultural field days. Farmers and farm workers avail themselves of this program while attending a field day. Once they enter the program they fill in a questionnaire about noise exposure, hearing ability, and other relevant information.

After the questionnaire is completed, they then have their hearing screened by a hearing health professional. The results of the screening and questionnaire are then interpreted and the farmer or farm workers are provided with a set of recommendations about maintaining their hearing health.

The program has been offered to farmers since the late 1980s and in its current form has provided in excess of 6,000 screenings. Due to rural people traditionally accessing fewer health services than their urban counterparts, the program was designed to be available during 'down time' and as such has enabled a number of farmers to have their hearing screened who would otherwise have missed out.

The evaluation consisted of a mail survey sent to a random stratified sample of participants. There were 5,013 farmers from New South Wales who had their hearing screened as part of the program between 1 January 1995 and 31 December 2001. Of the 1,000 individuals sampled, 15 were duplicates and 97 were returned unopened. Of the remaining 888 farmers, 64 per cent returned the survey. Of the 565 farmers who responded, 67 per cent reported that they had started using or increased their use of hearing protection since their field day hearing screening. The use of PHP for non-cabined tractors found a net gain of 13 per cent, for chainsaws 21 per cent, for firearms 7 per cent, and for workshop 21 per cent. Forty-one per cent of survey respondents had instigated strategies to reduce noise exposure beyond the use of PHP alone. Twenty-five per cent of those recommended to seek further hearing consultation followed through with the advice provided. Participants expressed a high level of satisfaction with the program, with very few reporting that the program was not helpful. Ninety-eight per cent felt that the field day hearing screening should continue and 97 per cent would recommend the program to other farmers.

It is clear from the results that the program has had a positive effect on farmers' hearing conservation behaviour. However, the results varied across commodity groups and noise exposures. The farmers who participated were highly satisfied with the program and recommended that it continue.

Based on the results of this evaluation, the authors recommend that the New South Wales Rural Hearing Conservation Program be continued and, where possible, expanded. The program clearly showed that farmers' behaviour in relation to noise injury prevention improved as a result of being part of the program.

1. To achieve a smoke free environment in the inpatient mental health units of Liverpool/Fairfield and Bankstown hospitals by September 2002 in line with the NSW Health Smoke Free Workplace policy; and
2. To trial and assess the effectiveness of an approach to managing nicotine dependence and/or quitting for people with a mental health problem or disorder while they are inpatients of the Liverpool/Fairfield or Bankstown mental health units from March 2001 - September 2002.

1. To develop policies and protocols regarding the management of nicotine dependence in a mental health inpatient facility including:
   - Appropriate recording of information on smoking status and level of nicotine dependence of ALL inpatients in medical records on admission from March 2001.
   - Establishing and maintaining accurate records of each patient's psychiatric diagnosis, offer of NRT, acceptance of NRT, use of NRT, significant side-effects including aggression, effects on other medication doses and alteration (if any) of smoking behaviour.
2. To increase the skills of staff and consumer advocates in managing nicotine dependence; to assess the uptake of NRT for patients in an inpatient unit over the following time frames:
   - Those who try NRT during their admission.
   - Those who use it during their entire admission.
   - Those who continue with NRT after discharge.

The Clean Air For All project aimed to establish procedures to assess and treat nicotine dependence in patients admitted to mental health units in the Sydney South West Area Health Service.

The records of 2407 patients were assessed during the project period. Follow-up interviews with patients who used NRT and surveys of nursing staff and GPs were also conducted. Just over half (56%) of the patients were identified as current smokers and assessment of nicotine dependence was completed for 35 per cent of patients who smoked. Of those patients who smoked who were also assessed for nicotine dependence, 81 per cent had medium, high or very high dependence scores, which meant they were eligible to receive the NRT intervention. The offer of NRT was made to 77 per cent of patients who were eligible to receive the NRT intervention, and 27 per cent of these patients chose to use NRT. Patches were the most common type of NRT used by patients (92%).

Findings from the project confirm that nicotine dependence is an important issue among patients of mental health units. The CAFA project demonstrated that NRT is acceptable to many staff and patients of mental health units and important for managing nicotine dependence in the context of a Smoke Free Workplace Policy. Patients also used NRT to assist them to attempt to quit smoking, even after discharge.

1. To develop interventions from evidence-based guidelines for best practice; and
2. To assess the effect of the interventions in terms of pharmacological measures such as the use of aspirin, cholesterol lowering medication and blood pressure lowering medication, as well as patient report of out patient (OP) advice on lifestyle factors such as smoking cessation, adequate physical activity and lowering fat intake and self reported lifestyle behaviours.

1. To develop two tools and accompanying guidelines to facilitate the implementation of the nutrition related Accreditation Standards for youth housing services in NSW by December 2002;
2. To determine the test retest and inter-rater reliability as well as the face and content validity of the two tools by December 2002; and
3. To determine the strengths and weaknesses of this model for policy development in a vulnerable group setting by December 2002.

The nutritional needs in adolescence are great since the rate growth at this stage of life is second only to that in infancy. Poor nutrition is linked to the permanent impairment of growth and development, as well as life long health problems, including increased risk of non-communicable diseases.

Improving food and nutrition practices in organisations that provide food to people is a major public health nutrition priority. A key strategy to bring about effective change is to have input into policy and regulations relating to nutrition at organisational, State and National levels.

Standards for accreditation of youth housing services were published in 1998 by the Department of Community Services, some of which related to nutrition. However, these standards were not developed in consultation with dietitians or public health nutritionists and are believed to be difficult to interpret, implement and monitor for compliance in a workforce lacking nutritional expertise. This project sought to develop and validate tools to assist youth housing services to meet the nutrition related standards. Two reviews of the literature were conducted; one to find recognised models or guidelines for the tools and the other to explore the accreditation systems and nutrition standards for other settings such as childcare and licensed boarding houses.

The project moved from developing new tools to assist services with implementing the existing standards, to developing new draft nutrition standards with reference to tools and resources already in existence. The new draft nutrition standards developed by this project were developed in consultation with experts and consumers.

As the project progressed the direction changed to focus more on building the capacity of services to support quality nutrition practices being part of youth work culture. This was to be achieved through advocacy, education and debate rather than focussing solely on accreditation standards and tools. There was also an opportunity to develop best nutrition practice with a comparatively well-resourced service that was setting up a new residential program.

The project will also identify strategies to address risk behaviours such as stealing, break and enter, drug & alcohol misuse and other related social issues which influence the current and future health of disadvantaged communities.

Strategies for mainstream health service providers to work within a health promoting and community development framework will also be identified and piloted within the scope of this project.

• to engage the participation of 8 to 12 year olds (target group) in the MAC in all phases of the project;
• to assess the appropriateness of current relevant programs/services that are available for the target group by June 2001;
• to identify the reasons for non-attendance at school and develop strategies of overcoming these by June 2001;
• to increase the capacity of mainstream health services to work more collaboratively with other Government, Non Government and Community groups, and also with services within the health system in addressing the needs of a disadvantaged community; and
• to decrease school absenteeism and participation in risk behaviour of 8 to 12 year olds in the Macquarie Fields Housing Estate by June 2002.

Report under development

1. Prioritise actions for capital work to address shortfalls that can reasonably be achieved over the next two financial years; and
2. Assess the acceptability and strength of this process to the parties involved; older people, health councils, health staff, Wellington Shire Council to determine if this is a workable system to use in the future.

The Safer Streetscapes for Older People Project assessed comments from older people about the streetscape environment and compared this to current Australian Standards to assess suitability of current standards to the identified needs of older people. Current standards do reflect a streetscape environment that is appropriate for older people; however, one of the challenges for all councils is upgrading existing streetscapes to meet new standards. This is a major issue for all councils, particularly those that have a shrinking ratepayer base due to population decline. Capital works of this nature are extremely expensive and as a result the streetscape environment is below current Australian Standards. This environment is likely to contribute to fall-related injury, or fear of fall-related injury, in older people.

Using qualitative methods, including semi-structured interviews and focus groups, researchers asked members of the target group to describe their experiences using the streetscape in the study area. The researchers also identified common pedestrian routes used by older people. The information provided by the target group through face-to-face interviews was enriched by information from focus groups with other older people living in Wellington who resided outside the study area. Throughout the project, researchers employed New South Wales Health's Capacity Building Indicators in an effort to determine both the strength of coalition with other sectors represented on the Advisory Committee and the sustainability of the project beyond the project time frame.

The major findings included identification of:

• the reasons why older people walk in the study area;
• a need for new concrete path construction in the study area;
• a need for concrete footpath maintenance in the study area;
• a lack of adequate seating on pedestrian routes in the study area;
• a perception that pedestrian crossings in the main street (Nanima Crescent) are dangerous for pedestrians;
• the hazards of high kerbing in Nanima Crescent;
• the hazards of people riding bikes and skateboards recklessly along Nanima Crescent; and
• the fear of unrestrained and/or unsupervised dogs.

The information gathered was prioritised and compiled into a report by researchers in collaboration with the staff of Wellington Shire Council. The report contained a list of 7 recommendations for action, which was presented to councillors and staff at a council meeting. All recommendations had the potential to be addressed by the council over the financial years between 2002 and 2008 (the council's strategic planning cycle). The recommendations were included in the Wellington Shire Council's 2003-2008 Strategic Corporate Management Plan.

Other actions were also initiated as a result of the research. Standards Australia advised that a ramp, identified by older people as being too steep, met the Australian Planning Standards when it was built but these standards have since been superseded. Problems of roaming dogs, people riding skateboards and bikes, and an unsafe pedestrian crossing, were also brought to the attention of the council. Signs were erected warning motorists of the presence of the pedestrian crossing, and signs highlighting bans on bike riding on the footpaths were erected in the main street. Speed limits in the area were introduced as part of a statewide initiative.

At the completion of the Safer Streetscapes Project in May 2004 an audit was conducted of the study area by researchers and council staff to determine which of the 7 recommendations adopted by the council had been acted upon. It was found that 3 of the 7 recommendations had been acted on at the time the audit was conducted.

The capacity building indicators used to assess the strength of the coalitions formed for the project indicated that the project partners had worked well together for a common purpose. There were some concerns among the project partners about the likely sustainability of the intervention given that many of the recommendations would require significant expenditure by the council.

The qualitative methods used in this project obtained valuable information from older people that could be articulated to community policy and decision makers by researchers as a means of advocating for changes to the streetscape. This process can be replicated with other community groups who have views about their local streetscape but who traditionally do not have a voice to express those views.

• the trained group will show greater improvement in mental health literacy than a wait-list control group. The change will mean that the trained group's beliefs are more like those of mental health professionals;
• The trained group will show a decrease in stigmatising attitudes compared to the wait-list control group; and
• The trained group will report a greater improvement in the frequency and type of helping behaviours towards people with mental health problems than the wait-list control group.

The sustainability component of the project will test the following hypotheses:

• The effects of Mental Health First Aid training will be sustained 18 months after completing a course. Sustainability will be seen in mental health literacy, stigmatising attitudes and helping behaviours; and
• When Mental Health First Aid is run on a fee-for-service basis over a 12 month period, trainers will continue to run courses.

1. To ensure the financial viability of Mental Health First Aid courses by running them on a cost-recovery fee-for-service basis, or by sponsorship, as are conventional first aid courses.
2. To secure the transfer of Mental Health First Aid from the ACT to the surrounding area of NSW. If the model is successful, it will form the basis for transfer to other regions.

Few Australians have good knowledge regarding mental health problems and many mental problems are frequently not diagnosed in primary care settings.

It is possible that greater mental health literacy will help a person better manage a potential or developing mental health problem in him or herself. Similarly, a person with greater mental health literacy should be in a better position to help family members and friends who develop a mental health problem. Greater awareness in the general community about mental illness will also help people recognise their problems and help them feel comfortable discussing these issues with their doctor. Thus any programme to increase the mental health literacy level of members of the general public can be seen as facilitating both mental health promotion and mental illness prevention.

The study will involve training instructors from southern NSW to deliver Mental Health First Aid courses in the region and then delivering Mental Health First Aid courses. Potential participants will be randomly assigned to either participate immediately in a course or to be placed on a wait-list control group.
Outcome measures will be:

• a short version of the mental health literacy questionnaire used in the National Survey of Mental Health Literacy to allow comparison of the participants’ beliefs with those of the public and health professionals;
• social distance questions to measure stigmatizing attitudes; and
• questions on what actions to others have been taken as a result of doing the course. Outcome measures will be administered before course commencement and at 6 months after course completion. 

To see if participants’ gains are maintained, there will be an 18-month follow-up interview for participants in the intervention group.

1. To enhance the capacity of hospital organisational units and individuals to create long-lasting changes in the care of smokers while inpatients;
2. Identify mechanisms for enhancing the dissemination effectiveness of state department policies and initiatives;
3. Indicate the effectiveness of the current lead agency model of dissemination; and
4. Create a series of capacity building products, including: audit, feedback and strategic planning tools which can be used in an ongoing way to ensure hospitals comply with the guidelines.

The project will compare uptake of the guidelines at two intervention hospital sites as compared to two 'usual care' control hospital sites. The uptake intervention will be based on strategies with demonstrated effectiveness for the dissemination of health-related guidelines within the framework of relevant models. The two control hospitals will continue existing care in terms of uptake of The Guide. The control sites will demonstrate the likely degree of change in the absence of funded dissemination strategies. Evaluation of the intervention will involve conducting qualitative interviews with relevant managerial staff, Computer Assisted Telephone Interviews (CATI) with consenting patients, auditing of patient notes for all consenting smokers, and medical records checks.

Report under development

1. Increase the proportion of students who walk all or most of the way to school on at least one school trip over the past week. (decrease in ‘car dependency');
2. Increase the proportion of students who walk all or most of the way to school on the majority of trips [at least 5 out of 10 trips per week] (increase in activity);
3. Increase the proportion of students walking continuously for 10 minutes or more on any trip to or from school;
4. Increase the proportion of students correctly identifying the benefits of walking; and
5. Increase students' positive attitudes towards walking to school.
6. Increase the mean frequency and duration of participation in out-of-school incidental and leisure time physical activity behaviour during a week, and
7. Increase students' awareness of road safety and environmental issues.

1. To develop an appropriate, evidence-based multi-factorial program to reduce hip fractures in aged care facilities
2. To test and document the feasibility of implementing the program;
3. To engage relevant stakeholders and project partners, including general practitioners;
4. To document the resources required to successfully implement the program;
5. To explore the sustainability of the intervention, notably with respect to identification of the resources required for ongoing maintenance of the intervention; and
6. To develop a model of intervention to be implemented across other Area Health Services in NSW and beyond.

1. To determine whether pedometers are a useful tool for increasing self reported physical activity, especially walking, and objective measures of cardiorespiratory fitness in Illawarra residents referred to outpatient cardiac rehabilitation (OCR);
2. To determine whether there is an effect of the pedometer on physical activity levels and cardiorespiratory fitness of Illawarra residents referred to OCR, between those who attend OCR and those who do not attend OCR; and
3. To identify the perceptions of Illawarra residents referred to OCR on the usefulness of pedometers for promoting physical activity.