Rosanne Freak-Poli

Highlights: New evidence is provided on the robust links between social relationships and mortality. Analysis uses 19 waves of Australian longitudinal data for individuals aged 50+. Functional and structural social relationships each independently predict mortality. Loneliness is most strongly associated with a higher mortality risk. Investing in social relationships would help protect against mortality risks.

Background: Public awareness and understanding of stroke are crucial to reducing its overall burden. Massive open online courses (MOOCs) are free, self-directed online learning platforms that provide accessible education. Objective: This study aimed to describe the process, outcomes, and evaluation of co-designing the Preventing Stroke MOOC. Methods: The co-design process was conducted with various stakeholder groups from July 2020 to December 2024 in Australia over three phases: (1) predesign, (2) co-design, and (3) postdesign. In the predesign phase, we consulted with MOOC researchers and held a half-day in-person workshop with community members to prioritize the stroke prevention topics, structure, format, and features, followed by user testing of a single developed module. The larger study comprised 16 virtual focus groups (14 co-design and 2 user testing focus groups) with community members and health knowledge experts. Of the 14 co-design focus groups, 12 informed the MOOC design, including content, structure, and delivery. This was followed by drafting content for each module, expert review (eg, clinicians and researchers), and development of platform materials. In the postdesign phase, we conducted user testing to collect feedback and evaluated the co-design process to determine how participants’ input shaped the final MOOC design. Results: In the predesign phase, 5 MOOC experts and community members contributed to a pilot module comprising 9 pages on the prioritized topics, including a focus on stories from people with lived experience of stroke. A total of 8 people tested this module, providing positive feedback about content and delivery. The co-design phase engaged 22 participants across 12 focus groups relevant to the MOOC. Their suggestions contributed to the multimedia design of the 7 core modules, with personalization via 9 optional mini-modules. Feedback on technical issues and suggested improvements identified during postdesign user testing were resolved. Evaluation of the MOOC co-design process found that the majority of participants’ suggestions gathered during the co-design phase were included in the final MOOC. Conclusions: A structured, co-design process resulted in the Preventing Stroke MOOC reflecting participants’ suggestions and provided important insights on the educational information needed to inform the general population about stroke prevention.

Background: Stroke affects one in four people globally, highlighting the need for novel approaches to primary prevention. The Love Your Brain digital platform comprises an online course and text messages to improve stroke knowledge and motivate behavior change for stroke prevention. Aims: To evaluate the efficacy of the platform over 12 weeks in increasing medical practitioner visits for cardiovascular risk assessment/management. Methods: We conducted a single-blinded, multi-arm randomized controlled trial. Eligible participants were community-dwelling Australians aged ⩾ 45 years with no history of cardiovascular events. Participants were randomized (1:1:1) to interventions (either online course or text messages) or control, stratified by age and gender. The primary outcome was a change from baseline to 12 weeks in self-reported medical practitioner visits for cardiovascular risk assessment/management. Secondary outcomes were knowledge of stroke, uptake of risk-modifying behaviors, and medication adherence. Log-binomial/generalized linear model regression was used, adjusting for stratification variables. Analysis was based on intention-to-treat. Results: A total of 941 participants (median age 67 years; 82.4% women) were randomized between 18 February 2025 and 17 September 2025 to control (n = 311), online course (n = 318), or text messages (n = 312). At 12 weeks, 82.6% completed follow-up. Self-reported visits to a medical practitioner at 12 weeks exceeded those of the control (29.0%) in the text message arm (41.3%; RR: 1.43, 95% CI = 1.14–1.80, P = 0.002), but not the online course arm (31.2%; RR: 1.08, 95% CI = 0.83–1.40). Stroke knowledge increased in both intervention arms (Online: Coeff: 1.13, 95% CI = 0.75–1.50; Text message: Coeff: 0.58, 95% CI = 0.19–0.96) compared with the control. No differences were observed for other outcomes. Conclusions: The text message intervention increased medical practitioner visits for cardiovascular risk assessment/management among community-dwelling adults without prior cardiovascular events. The online course was ineffectual, potentially due to low completion. The text message intervention warrants scale-up to support primary stroke prevention. Registration: ACTRN12625000124437.

Data on commonly reported unmet needs poststroke are crucial to inform interventions and ongoing care of survivors. We aimed to synthesize contemporary data on the prevalence of unmet needs among survivors in the community, and associated factors. We searched MEDLINE, Embase, and CINAHL for articles with prevalence estimates on unmet needs poststroke. Only articles comprising data collected from 2013 to June 2025 from survivors living in the community or their proxies were included. A random-effects model was used to meta-analyze prevalence, whereas associated factors were summarized. Of 1,233 articles screened, 19 were eligible for inclusion (n = 8,138 participants), including 13/19 with data on associated factors, and one from a low-to-middle-income country. Overall, 68 unique unmet needs were identified across six domains: body function (n = 13), cognition/mental health (n = 10), social/community integration (n = 7), activity/participation (n = 14), service/information (n = 11), and recovery (n = 13). The pooled prevalence of reporting ≥1 unmet need was 65%. Unmet needs with the greatest pooled prevalence estimates were those related to education/information on stroke (60%), fatigue (49%), concentration (46%), headache (37%), anxiety/depression (36%), and diet (36%). Factors that were commonly associated with reported unmet needs include those related to social determinants of health (most commonly age and sex), stroke type/severity, poststroke care (most commonly length of hospital stay and poststroke services), multimorbidity, and health and well-being. We provide contemporary data on unmet needs among stroke survivors in the community, and associated factors. Our findings could inform more tailored support, particularly psychological support, for survivors in the community. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Background: Stroke is common, affecting an estimated one in four people in their lifetime. Fortunately, stroke is also highly preventable. With the rise in digital literacy and the increasing adoption of digital health tools, a promising avenue for stroke prevention is through digitally-delivered interventions. Love Your Brain: A stroke prevention digital platform is a three-year research project to develop and evaluate a digital platform to 1) increase participant visits to their medical practitioner for assessment or management of cardiovascular risk factors (primary outcome); and 2) improve participants’ health-related stroke knowledge, adherence to prevention medications and uptake of healthy or risk-modifying behaviour (secondary outcomes). The project is a multi-arm randomised controlled trial, comparing the common control arm to each of the intervention arms (either an online course or text messages). We present the statistical analysis plan for this trial. Methods/design: Participants are randomised 1:1:1 in variable block sizes, with stratification balancing by age and sex. The sample size of 894 participants was calculated to detect a 30% relative intervention effect, with 80% power and 5% significance level (two-sided). Recruitment will end when the sample size is achieved (adjusting for ≤ 10% attrition rate). The primary outcome will be compared separately for each intervention arm with the common control arm. As the outcome is binary, log-binomial regression models will be used with adjustment for stratification variables (i.e., gender, age groups [45–64 and >= 65 years]) and covariates that demonstrate imbalances between arms at baseline. Secondary outcomes will be evaluated using generalised mixed effects regression models (including linear, log-binomial, or quantile regression). The primary outcome analysis will be based on intention-to-treat. A p-value ≤ 0.05 will indicate statistical significance. Conclusions: This statistical analysis plan ensures transparency in reporting the trial outcomes. Love Your Brain will provide novel evidence on the effectiveness of two digital health education platforms for the prevention of stroke. Trial registration: ACTRN12625000124437; U1111-1305-2964 Feasibility Pilot: Australian New Zealand Clinical Trials Registry: ACTRN12624000540516; Universal Trial Number: U1111-1305-2964. SAP Version: 1.0 (September 2025) Protocol version: 1.0 (December, 2024) SAP revisions: Nil

Aim: This study aimed to examine the longitudinal associations between public library visits and multiple health and well-being outcomes in older adults. Subject and methods: We analysed data from over 12,000 ( n range, 12,124–12,896) relatively healthy community-dwelling Australians aged 70+ years. We categorised public library visits as never, ≤ 3 times/month, and ≥ once/week. Using an outcome-wide analytical approach, we examined associations between public library visits and 44 outcomes across physical, cognitive/major health events, psychological, social, and behavioural domains. Most outcomes were assessed at ~2 years of follow-up, with extended follow-up for time-to-event outcomes (median duration range, 6–9 years). We performed gender-disaggregated regressions, adjusting for multiple covariates. Results: Participants were aged 70–95 years (mean 75.2 ± 4.3) at baseline, and 54.5% were women. More women than men reported visiting public libraries (70.6% vs 59.9%). Public library visits were associated with better physical and cognitive outcomes (e.g., reduced dementia risk), social well-being (e.g., lower social isolation in women), and healthier behaviours (e.g., increased fruit and vegetable intake) at follow-up. No associations were found with most psychological outcomes. Gender differences were observed: men had stronger associations with reduced disability and mortality over 7 years, while women showed associations with greater social well-being and health-promoting behaviours, and a higher fall risk ~2 years later. Conclusion: Public library visits were generally associated with improved health and well-being in older adults. As inclusive and trusted community institutions, libraries may represent a promising avenue for social engagement and health promotion within population-level public health strategies.

Neighbourhood houses are community‐led centres that provide accessible spaces for learning, social connection and wellbeing. Despite their alignment with state and national wellbeing strategies, their contributions remain undervalued in policy and funding decisions. This study aimed to examine reasons for engagement and perceived benefits among attendees at Bridge Darebin Neighbourhood House, a long‐established community hub in northern Melbourne, Australia. A cross‐sectional, community‐led census was conducted in August–September 2024, collecting quantitative and qualitative data from 204 participants aged 13 years and older. The survey captured demographics, patterns of participation, motivations for engagement and self‐reported impacts on wellbeing, social connection and practical skills. Data were analysed using descriptive statistics, X ² tests and framework‐based qualitative content summarisation of open‐text responses. Most participants were women (76%), aged 30–64 years (68%) and resided locally (53%). Engagement was primarily for courses or classes (54%), exercise and health programmes (19%), social groups (15%) or café visits (15%), with referral mostly via friends, other community organisations or online sources. Participants reported an average of 3.8 benefits each, most commonly spending time with others, improving personal wellbeing and confidence, meeting new people and developing new skills. Significant positive outcomes included improved overall wellbeing (76%), stronger social connections (76%) and enhanced support networks (54%). Qualitative findings highlighted age‐ and role‐specific pathways to benefit, including creativity and social engagement for younger adults, health maintenance and routine for older adults, practical skill‐building for men and mental health improvements for nonbinary participants. These findings show that neighbourhood houses function as low‐threshold, inclusive and empowering spaces that strengthen social, emotional and practical wellbeing across diverse demographic groups. Supporting neighbourhood houses through sustainable funding, integration with government initiatives and structured evaluation can enhance their capacity to deliver equitable, high‐impact, community‐led wellbeing outcomes.