Lidia Engel

Timely diagnosis of dementia is critical, as early identification enables interventions that can meaningfully improve quality of life and support long-term planning for individuals and their families. Despite this, many Australians continue to receive a diagnosis at a late stage due to a range of personal, social, and structural barriers. BrainTrack, a freely available and evidence-based mobile application, was developed to help address this gap by supporting users to monitor their cognitive health and encouraging earlier engagement with healthcare professionals when concerns arise. This study sought to assess the broader social and economic value generated by BrainTrack. A Social Return on Investment (SROI) framework was employed to quantify the social outcomes associated with the app. Survey data collected 12 months after initial use captured five key outcomes: increased dementia literacy, enhanced dementia knowledge, reduced stigma, greater motivation to adopt cognitive health-promoting behaviours, and increased help-seeking intentions. Monetary values were assigned to each outcome to estimate the value created. Inputs included the resources invested in BrainTrack, such as initial development costs and ongoing maintenance. To determine the net impact, adjustments were made for deadweight, displacement, attribution, and drop-off prior to calculating the SROI ratio. Survey responses from 2,339 BrainTrack users informed the analysis. With an investment of AU$1.9 million over five years, the SROI analysis estimated a social return of approximately $5 for every $1 invested in BrainTrack. Sensitivity analyses showed ratios ranging from AU$0.86:1 to AU$24:1. The largest proportion of estimated social value was associated with increased motivation to change, whereas reduced stigma and increased help-seeking were associated with comparatively smaller estimated social value. Overall, BrainTrack was associated with social and economic value through cognitive self-monitoring, increased dementia awareness, and greater engagement with health services.

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.

Objectives: Despite growing interest in incorporating informal carer outcomes into economic evaluations, evidence on the performance of utility measures for informal carers remains limited. This study assesses the psychometric performance of the EQ‑5D‑5L and EQ‑HWB‑9 in capturing informal carer outcomes for economic evaluations. Methods: This study utilized cross-sectional EQ-DAPHNIE survey data from English‑speaking countries (Australia, Canada, New Zealand, UK, and US) to evaluate the EQ‑HWB‑9 (UK pilot value set) and EQ‑5D‑5L (country‑specific value sets), assessing distributional (i.e., acceptability, distribution, floor and ceiling effects) and construct validity (i.e., convergent and known-group) properties, with subgroup analyses by age and financial situation. Results: There were 6,743 informal carers across Australia ( n = 1447), Canada ( n = 1265), New Zealand ( n = 1435), UK ( n = 1337), and US ( n = 1259). The EQ-5D-5L showed a ceiling effect (19%), but not the EQ-HWB-9 (5%). Most respondents reported problems (level 2–5) on the EQ-5D-5L pain/discomfort (67%) and anxiety/depression (60%), with anxiety/depression showing the highest proportion with worst (level 5) responses (5%). For the EQ-HWB-9, ≥ 50% reported problems (level 2–5) across all domains except mobility, with ≥ 5% reporting the worst (level 5) responses in exhaustion, loneliness, cognition, sad/depressed, anxious, and control. Both instruments moderately correlated with the WHO-5, PROMIS-10 (physical and mental t-scores), ASCOT-SCT4, OPQOL-brief, PHQ-2, and GAD-2, and demonstrated known-group validity across groups relating to self-reported physical and mental disability, chronic conditions, sleep, social support, impact of caring, psychological wellbeing, and self-reported quality-of-life. Results were consistent in subgroup analyses. Conclusion: This study provides evidence supporting the acceptability and construct validity of the EQ-5D-5L and EQ-HWB-9 in measuring informal carer outcomes for use in economic evaluations. Responsiveness evidence remains limited and warrants further research.

Objectives: This paper reports the health economic component of the broader Promoting Independence Through Quality Dementia Care at Home (PITCH). The broader PITCH trial primarily evaluated the effect of dementia training on home care workers' competence in providing dementia care; this analysis evaluated intervention costs and selected secondary client and caregiver outcomes. Methods: The PITCH intervention was tested via a multi‐site national pragmatic stepped‐wedge cluster randomised clinical trial, conducted across three Australian states. A micro‐costing approach was used to estimate intervention and resource use costs. Secondary outcomes for clients and caregivers, including quality of life (QoL), caregiver burden and dyadic interaction, were assessed. Means (SDs) described costs and outcomes, with linear and multilevel mixed‐effects regression used to estimate crude and adjusted mean differences, respectively. Results: There were no significant improvements in most client and caregiver health, QoL, caregiver burden or dyadic interaction outcomes during the intervention phase, with decreases in proxy‐reported Dementia QoL Utility (DEMQOL‐U) and client self‐reported visual analogue scale (EQ VAS). Improvements in caregiver burden and dyadic interaction were observed but were not statistically significant. Total costs increased from AU$68,925 in the control to AU$133,660 in the intervention phase, with an adjusted mean difference of AU$67,146 (95% CI: AU$16,957 to AU$117,334). Conclusions: This health economic analysis should be interpreted separately from and alongside, the main PITCH trial findings on the primary outcome of home care workers' competence. Within this secondary analysis, PITCH was associated with higher total costs during the intervention phase and no clear evidence of improvement in the selected secondary client and caregiver outcomes.

Background and Objective Providing informal care to a person with dementia can substantially affect carers’ quality of life. Existing generic preference-weighted measures (e.g. EQ-5D-5L) may not fully capture the caring experience, while carer-specific measures (e.g. CarerQol), although preference weighted, cannot be used to derive quality-adjusted life-years for cost-utility analysis. The COCOON project aimed to develop a new preference-weighted quality-of-life measure for carers of people living with dementia that is suitable for cost-utility analysis. Methods Development of the descriptive system was informed by: (1) a literature review; (2) qualitative interviews with carers of people with dementia to assess face validity of candidate items; (3) an online survey of carers to evaluate psychometric performance (including missing data, distributions, known-group validity, convergent validity, exploratory factor analysis and item response theory analysis); and (4) consultation with an advisory group. Results An initial pool of 60 candidate items was reduced to 44 items for qualitative testing. Following interviews, the item set was refined to 35 items. Based on psychometric analyses and final advisory group consultation, the final descriptive system comprised seven items: emotional health, physical health, loss and grief, loss of freedom, loneliness, support and financial burden. Each item is measured using a five-point frequency scale from ‘never’ to ‘always’. Conclusions The COCOON measure is grounded in the lived experiences of carers of people living with dementia, capturing the multidimensional facets of dementia caregiving and offers a conceptually robust and policy-relevant measure for assessing carers’ quality of life in economic evaluations.

This study aimed to evaluate the cost effectiveness of delivering treatment interventions for major depression among Ethiopian adults aged 18-64 years. A multiple cohort Markov model was developed to simulate how population cohorts move between three health states over time: healthy, depression and dead. Three drug interventions (tricyclic antidepressants [TCAs], selective serotonin reuptake inhibitors [SSRIs] and serotonin norepinephrine reuptake inhibitors [SNRIs]), one non-pharmacological therapy (psychotherapy) and one combination therapy (drug plus psychotherapy) were compared to a common comparator, a partial null scenario. We modelled interventions for Ethiopians aged 18-64 years with major depression in 2021 (n = 2,431,898). The study employed a cost-utility analysis framework to estimate the incremental cost-effectiveness ratios (ICERs), expressed as a cost per quality-adjusted life year (QALY). The model was run over a 10-year period, adopted a health sector perspective to estimate population-level costs and benefits with a 3% annual discount rate. Uncertainty analysis was conducted using a Monte Carlo simulation with 3000 iterations. Psychotherapy was associated with incremental cost of US$17million (M) (95% CI US$9M-US$26M) and QALY gains of 11,857 (95% CI 125-35,227). In comparison, antidepressants, such as SNRIs, had a higher cost of US$236M (95% confidence interval [CI] US$132M-US$353M) with QALY gains of 15,369 (95% CI - 304 to 50,059). Combination therapy was associated with the highest health benefit (40,755 QALYs [95% CI - 210 to 124,928]) and incurred an incremental cost of US$162M (95% CI US$89M-US$244M). The ICER for psychotherapy was US$1,419 per QALY gained (95% CI US$344-US$22,433/QALY), suggesting cost effectiveness when adopting a one-times GDP per capita per QALY threshold. In contrast, combination therapy had an ICER of US$3,973/QALY (95% CI dominated to $63,677/QALY) and may be an appropriate option for individuals requiring both pharmacotherapy and psychotherapy. Conversely, drug therapies did not appear to be cost effective. Psychotherapy appears to be a cost-effective intervention in Ethiopia, while combination therapy may be an alternative cost-effective option. However, access to psychotherapy and combination therapy in Ethiopia is currently restricted to hospitals and the private sector, largely due to a shortage of trained professionals such as clinical psychologists. To address this gap, policymakers should explore cost-effective strategies to expand the availability of psychotherapy services.

Background: Loneliness and social isolation are major public health challenges linked to premature mortality and significant healthcare and productivity costs. However, their geographic distribution and socio-demographic determinants remain poorly understood, with few studies applying spatial methods to identify high-need areas and protective factors. Methods: This study aimed to investigate the geographic distribution and determinants of loneliness and social isolation across Australia using a spatial epidemiological approach. Utilising longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey, along with Australian Bureau of Statistics (ABS) census data, greenness vegetation index and walkability index, we employed Bayesian conditional autoregressive (CAR) models to assess spatial and temporal patterns at the Statistical Area Level 3 (SA3) over a 22-year period and present the relative risks (RR) and credible intervals (CrI). Results: Our analysis revealed spatial variation in the RR of both loneliness and social isolation, with notable hotspots in socioeconomically disadvantaged areas. In multivariable models, area-level socio-economic disadvantage (as measured by the Index of Relative Socio-economic Advantage and Disadvantage, IRSAD) (RR = 0.8, 95% CrI: 0.76–0.85) for the highest quintile (most advantaged) and a higher prevalence of depression and/or anxiety (RR = 4.3, 95% CrI: 3.0–6.1) were associated independently with relative risk of loneliness but not with age structure, remoteness, green space or walkability index. For social isolation, higher average hospital admission rates per region were the strongest factor. Conclusions: The spatial heterogeneity observed in our study underscores the need for place-based public health responses, including community-based interventions and targeted resource allocation, especially in disadvantaged communities.

BACKGROUND In Australian residential aged care, infection prevention and control (IPC) lead nurses are a key part of the IPC program. IPC Leads are often the main IPC contact 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 others 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 lead nurses in one 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 for change in IPC Leads’ self-efficacy. It will also explore job satisfaction, IPC practice improvement and assess the acceptability and feasibility of CoPs. METHODS A before-and-after study design using multi-methods. 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 30-60 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 12-months follow-up, surveys and interviews with IPC Leads will be assess acceptability and feasibility of the CoPs and explore case examples of IPC Leads facilitating practice change. Researcher notes and costings data collected will be used to further evaluate the feasibility and fidelity of the CoPs. RESULTS This project was funded in October 2024 and commenced in February 2025. Recruitment of IPC Leads began in March 2026. The CoPs are expected to commence in June-July 2026. Data collection will commence in June 2026 and is expected to be completed by January 2028. CONCLUSIONS Findings will create new research knowledge in the field of CoPs and knowledge translation in the aged care sector and will inform the sustainability and potential for future scale-up of this collaborative social learning approach. CLINICALTRIAL Not applicable