Luke Wolfenden

Background: In Australian residential aged care, infection prevention and control (IPC) Lead nurses (IPC Leads) are a key part of the IPC program. IPC Leads are often the main IPC contacts and provide support to staff to improve IPC and resident outcomes. To enhance their competence and self-efficacy, IPC Leads need to engage in ongoing role development. Connecting with other IPC Leads, learning together, and sharing ideas and resources could also be beneficial. Communities of practice (CoPs) have been shown to improve self-efficacy and job satisfaction by fostering belonging, peer learning, and problem-solving. Drawing on social learning theory, CoPs encourage learning with and from one another to explore and iteratively develop practice. This study draws on the CoP literature and builds on our previous pilot of a CoP for IPC Leads in 1 state of Australia, which found promising impacts on confidence and practice change. Objective: This study will evaluate CoPs for IPC Leads working in Australian residential aged care. Primarily, the study will assess changes in IPC Leads’ self-efficacy. It will also explore job satisfaction and IPC practice improvement and assess the acceptability and feasibility of CoPs. Methods: We are conducting a before-and-after study using multimethods. We will recruit IPC Leads from across Australia to participate in the CoPs. The CoPs will be implemented over 12 months, with online sessions held monthly for 30 to 60 minutes each. Baseline and 12-month follow-up surveys of IPC Leads’ self-efficacy and job satisfaction and audits of IPC practice will be conducted. At the 12-month follow-up, surveys and interviews with IPC Leads will be used to assess the acceptability and feasibility of the CoPs and to explore case examples of IPC Leads facilitating practice change. Researcher notes and costing data collected will be used to further evaluate the feasibility and fidelity of the CoPs. Quantitative data will be summarized descriptively, and an ordinal mixed-effects model with a logit link will be used to assess change in self-efficacy. Interview data will be analyzed using an inductive approach, followed by a deductive approach, based on the Framework Method. Results: This project was funded in October 2024 and commenced in February 2025. As of April 30, 2026, 97 potential participants had registered their interest in participating, but no participants had been enrolled (ie, consented to participate). Recruitment of IPC Leads began in March 2026. The CoPs are expected to commence in June to July 2026. Data collection will commence in May 2026, and data analysis is expected to be completed by January 2028. Study results are expected to be published in 2028. Conclusions: The findings will create new research knowledge in the field of CoPs and knowledge translation in the aged care sector and inform the sustainability and potential for future scale-up of this collaborative social learning approach.

Issue Addressed: Schools are recommended settings for promoting healthy eating, but to achieve population‐level impact, initiatives must be widely implemented. Limited data are available to assess the implementation of Australian school‐based healthy eating initiatives. This study examined the implementation of healthy eating initiatives in Australian primary schools and whether implementation is associated with school characteristics (school size, remoteness, socio‐economic status). Methods: A cross‐sectional study surveyed a nationally representative sample of Australian primary school principals (August 2022–October 2023) regarding 32 healthy eating initiatives across five opportunities for healthy eating: healthy food in the classroom, at school, brought to school, outside of school and other. Initiatives were identified from recent systematic reviews aligned with Australian and global guidelines. Prevalence estimates were weighted to the national school population, and logistic regression models examined associations with school characteristics. Results: Of the 669 participating schools, 569 completed the healthy eating survey, with implementation rates ranging from 7% to 97%. The most frequently implemented initiatives were: in the classroom, ‘Permission or breaks to drink water in class time in ≥ 80% of classes daily’ (97%); at school, ‘Install water stations for free access to cooled plain or optionally carbonated water’ (64%); brought to school, ‘Information on healthy eating sent home to parents’ (88%); and outside of school, ‘Healthy eating programs delivered in partnership with community organisations or services’ (31%). Ten initiatives were associated with school size ( n = 5), remoteness ( n = 7), or socio‐economic status ( n = 3). Conclusions: Implementation rates of the 32 healthy eating initiatives varied substantially, and most initiatives had similar rates across school characteristics (school size, remoteness, socio‐economic status). So What?: This first national study provides crucial information on the implementation of individual healthy eating initiatives in Australian primary schools, highlighting which initiatives and school subgroups require policy and practice investment to support implementation.

Amédé Gogovor and colleagues explain how scaling studies differ from implementation studies and present 33 recommendations for how to report scaling studies with maximum accuracy and usefulness.

Background: Global breastfeeding rates remain below recommended levels. Parent-targeted digital health interventions (DHIs), including mobile health (mHealth) and eHealth strategies, offer a scalable way to support breastfeeding, but their effectiveness remains uncertain. Objective: The aim of this study is to explore the effectiveness of parent-targeted DHIs for improving breastfeeding outcomes. Methods: In total, 7 databases were searched on December 9, 2025, for randomized controlled trials (RCTs) involving parents of children younger than 5 years of age. Eligible interventions aimed to promote breastfeeding and were primarily delivered via digital mediums. Primary outcomes of interest included exclusive breastfeeding (EBF), any breastfeeding, and breastfeeding duration. Secondary outcomes included breastfeeding self-efficacy, cost-effectiveness, and adverse events. Random effects meta-analyses were conducted in accordance with Cochrane methods, and results were reported following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was graded using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: In total, 46 (39 RCTs and 7 cluster RCTs) studies, including 33,785 participants from 18 diverse countries, were included. A total of 25 of the interventions focused on mHealth strategies, 8 were delivered via computer-based eHealth, 4 by telehealth, and 9 were delivered by eHealth or mHealth combined with telehealth. Risk of bias was indicated with “some concerns” or “high risk” for 41 (89%) studies. Pooled results indicated that DHIs can significantly improve the odds of EBF (odds ratio 2.58, 95% CI 1.91-3.50; I ² =83%; 39 trials, 11,601 participants); however, considerable heterogeneity was present, and certainty of evidence was very low. Pooled results indicated with moderate certainty that DHIs may improve breastfeeding duration (standardized mean difference 0.48, 95% CI 0.29-0.67; I ² =0%; 7 trials, 716 participants). Results suggest that DHIs have no effect on the odds of any breastfeeding (odds ratio 1.09, 95% CI 0.90-1.31; I ² =19%; 21 trials, 8991 participants), but the certainty of evidence is very low. Cost or cost-effectiveness and adverse events were scarcely reported. Conclusions: This review provides a comprehensive synthesis of global evidence exploring the impacts of parent-targeted DHIs on breastfeeding outcomes, spanning diverse cultural and health system contexts. Our results suggest that parent-targeted DHIs represent a promising strategy for improving key breastfeeding indicators, such as EBF and breastfeeding duration with very low to moderate certainty, as current evidence is limited by variable risk of bias, potential publication bias, and substantial heterogeneity. DHIs could have a complementary role as part of the health care and support provided to parents during the first 2000 days. Future trials should seek to minimize possible biases as well as capture key scale-up outcomes to justify embedding such innovations within existing health systems and structures.

Background: The first 2000 days can profoundly influence long-term health. Healthy Beginnings for Hunter New England Kids (HB4HNEKids) is an SMS text messaging program delivered alongside routine Child and Family Health Nursing (CFHN) care, which provides families with evidence-based, age- and stage-related preventive health information across the first 2000 days. Objective: This pilot study aimed to explore the feasibility, engagement, and acceptability of the HB4HNEKids program. It also aimed to explore the potential effectiveness of the program at 6 and/or 12 months post partum on outcomes including breastfeeding, child diet, child movement, and parental mental well-being. Methods: During the pilot phase (October 2021 to July 2024), project records were used to assess the number of families enrolled, number of SMS text messages sent (feasibility), and the number of opt outs (engagement). Repeat cross-sectional surveys were conducted at 5‐7 months post partum and again at 12‐14 months post partum using validated survey instruments. Using convenience sampling methods, survey participants consisted of birthing parents who had received HB4HNEKids and a concurrent nonrandomized comparison group that did not receive the program. Surveys assessed parental self-reported engagement with the messages, program acceptability, breastfeeding status, child diet, child movement, and parental mental well-being. Mixed linear regression analyses were conducted to calculate mean differences and odds ratios. Results: During the pilot phase, HB4HNEKids was delivered to 6243 families (73.4% of families contacted by CFHN). A total of 383 birthing parents completed the survey at 6 months (99/383, 26% receiving HB4HNEKids), and 283 completed the survey at 12 months (104/283, 37% receiving HB4HNEKids). Of the survey participants who received HB4HNEKids (n=200), between 76% and 83% reported that they always or very often read the SMS text messages, spending on average 5‐7 minutes engaged with the content. At both survey time points, more than 90% of participants receiving HB4HNEKids agreed that the program was acceptable. Child daily intake of vegetables was significantly higher in the HB4HNEKids group (adjusted mean difference 0.23, 95% CI 0.07-0.40; P =.006) than in the comparison group at 12 months. Parents receiving HB4HNEKids also reported significantly better mental well-being scores ( P =.005). While HB4HNEKids participants reported breastfeeding rates 5 percentage points greater than comparison participants at 6 and 12 months, this result was not statistically significant. There were no statistically significant differences between HB4HNEKids, and comparison participant responses related to child movement behaviors. Conclusions: The HB4HNEKids SMS text messaging program is feasible to deliver at scale alongside routine CFHN care and is highly acceptable and engaging to parents. This pragmatic evaluation of the pilot, embedded into usual care, indicates potential effectiveness of the program for improving child vegetable intakes and parental mental well-being. Further evaluation of this program using robust methodology is needed to determine the effectiveness of this innovative mHealth program across the first 2000 days.