Ben Harris-Roxas

In Australia, oral opioids have increasingly been prescribed for chronic pain with limited effectiveness, attendant side effects and risks including the development of opioid dependence. In primary care, opioid dependence in chronic pain patients prescribed opioids is underrecognised, underdiagnosed and as a consequence undertreated. This may lead to sometimes severe adverse health outcomes. This longitudinal qualitative study analysed two waves of semi-structured interviews undertaken with 24 general practitioners (GPs) working in community general practice in New South Wales (NSW), Australia, between 2021 and 2023. The theory of planned behaviour (TPB) framed these interviews. TPB has three factors: attitudes, social norms and perceived behavioural controls. The positive and negative valences of these factors may impact intention to undertake a specific behaviour. In this case, the intention of participants to diagnose and manage opioid dependence in their patients’ prescribed opioids for chronic pain. Over the study period, some participants reported changing social norms, with patients increasingly flagging concerns regarding their opioid use. This led to fruitful conversations about opioid dependence between participants and their patients and positive experiences diagnosing and managing opioid dependence, including commencing treatment with methadone or buprenorphine. This led to more positive attitudes and strengthened intention for participants. Behavioural controls, including supportive workplace and colleagues, change in role, increased knowledge, expanded skills and easy access to specialist support, also strengthened intention. Participants were enthusiastic about the benefits of a newly introduced real-time prescription monitoring tool; however, this did not appear to change their approach to the diagnosis or management of opioid dependence. Overarching these experiences were the impact of the coronavirus pandemic and an exodus of participants from Medicare supported general practice work. To improve GPs' intention to undertake the diagnosis and management of opioid dependence for patients prescribed opioids for chronic pain, a raft of changes need to be implemented.

Background: General practitioners (GPs) are often the first point of professional contact for Australian adolescents experiencing depression and anxiety, and play a central role in facilitating access to specialist mental health care. However, increasing demand and constrained service availability have resulted in prolonged wait times. Little is known about how GPs manage adolescent mental health care during these delays. This study explored Australian GPs’ experiences of wait times for adolescent mental health services, including referral practices, access to wait time information, perceived impacts of delays and strategies used to support adolescents while awaiting treatment. Methods: A national cross-sectional online survey was conducted between May and November 2022 with Australian GPs who treated adolescents aged 12–17 years with depression and/or anxiety. Survey items examined referral practices, estimated and acceptable wait times, access to wait time information, perceived impacts of delays, and interventions recommended during waiting periods. Descriptive statistics, ordinal correlations and thematic analyses of free-text responses were conducted. Results: The final sample comprised 190 GPs (71.6% female; mean age 42.38 years, s.d. 10.25). Most frequently treated adolescents with depression and/or anxiety, and 80.0% reported increased presentations over the previous year. GPs most commonly referred adolescents to psychologists (92.1%), and frequently recommended ongoing GP appointments and lifestyle modifications. Estimated mean wait times ranged from 24 days for inpatient services to 113 days for psychiatrists, substantially exceeding GPs’ proposed acceptable waits of 7–26 days. Most GPs considered wait times for psychologists (86.7%) and psychiatrists (89.4%) unacceptable. Most GPs increased their level of care during prolonged waits (82.1%), and perceived delays as contributing to symptom deterioration, treatment disengagement, reduced help-seeking and increased self-harm or suicide risk. Despite viewing interim support as highly important, most GPs rated their knowledge of effective wait time strategies as only basic or adequate. Conclusions: Australian GPs are providing substantial interim mental health care for adolescents during prolonged delays to specialist treatment within a constrained system. Improving youth mental health system capacity, alongside strengthening GP training, resources and access to evidence-based supports, may improve care during extended waiting periods.

Trauma and social disadvantage are strongly associated with higher rates of chronic disease, partly driven by modifiable risk factors such as physical inactivity and poor diet. Despite strong evidence supporting exercise and dietary interventions for both physical and mental health, access to allied health professionals—particularly exercise physiologists, physiotherapists and dietitians—remains profoundly inequitable. Current prevention efforts predominantly reach individuals with stable living conditions and sufficient resources, ultimately privileging the privileged and entrenching health disparities. To close these gaps, these workforces must be reoriented: embedded within trusted community settings and delivered earlier in the care pathway, in ways that are trauma‐informed and responsive to social context.

Background: People from Bangladeshi and Nepalese origin living in Australia experience a disproportionate burden of chronic diseases, such as diabetes and cardiovascular diseases. Although preventive services are essential to reduce the burden of chronic diseases, existing evidence indicates that these communities encounter unique migration, socioeconomic and health system‐level challenges that impede their access to existing preventive services in Australia. The present study therefore explored the barriers and facilitators to accessing preventive care services among people of Bangladeshi and Nepalese origin living in Sydney, Australia. Methods: This qualitative study was conducted within a constructivist paradigm, which recognizes that realities are constructed through participants' lived experiences. Six focus group discussions (FGDs) and 22 in‐depth interviews (IDIs) were conducted between August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney, Australia. FGDs and IDIs were conducted in participants' native language, transcribed verbatim, translated into English and thematically analysed. The identifed barriers and facilitators to accessing preventive services were organized across multiple levels using the socio‐ecological framework. Results: Several barriers and facilitators relevant to the contextual experience of people from Bangladeshi and Nepalese backgrounds were identified across multiple levels of the socioecological framework. At the individual level, key barriers included cultural and religious perceptions, limited health literacy and low awareness of available preventive care services. Interpersonal barriers included limited English language proficiency, inadequate availabilty of translated health education materials and interpreter services, and limited cultural understanding among health care providers. Community‐level barriers comprised chronic disease‐related stigma and low level of community engagement. At the institutional and policy levels, barriers included limited culturally tailored support services and infrequent public transport to health care facilities. Conversely, facilitators across these levels included self‐awareness and personal ownership of health, knowledge of available preventive services, peer support network, cultural and linguistic competence of health care providers, the use of digital and social media for health information dissemination, and the supportive role of community organisations. Conclusion: These findings suggest the need for implementing multi‐level, culturally tailored, community‐led interventions that leverage existing community and social engagement platforms to ensure equitable access to available preventive services for chronic diseases among these disadvantaged population groups in Australia. Patient or Public Contribution: Study participants contributed to research by sharing their lived experiences of accessing preventive services for chronic diseases. The shared linguistic and cultural backgrounds between the researchers and participants helped rapport‐building and supported in‐depth exploration of the complex factors influencing access to preventive care. Participants provided valuable insights through participating in IDIs or FGDs, which formed the basis of the study findings. However, participants were not directly involved in the study design or conduct of the study, data analysis or interpretation or manuscript preparation.

Background: Health literacy is associated with improved healthcare experiences and health outcomes and is influenced by the social context in which it occurs. People with intellectual disability face stark health inequalities, yet the health literacy concept is underexplored for this group. Little is known about how health literacy is co‐constructed between people with intellectual disability, supporters and healthcare professionals. Objective: The aim is to understand the experiences of people with intellectual disability accessing, understanding, appraising and applying health information together with their supporters and healthcare professionals. Search Strategy: This scoping review followed Joanna Briggs Institute guidelines. Articles were identified and retrieved from CINAHL, PsycINFO, PubMed and EMBASE. Articles were included if they were published between 2000 and the present and focussed on aspects of how people with intellectual disability accessed, understood, appraised or used information or the role that socio‐environmental influences, including support networks and healthcare professionals, have in this process. Data Extraction and Synthesis: Two reviewers completed abstract and full‐text screening, addressing any conflicts at each stage. Data were extracted and coded deductively, according to the integrated model of health literacy. Main Result: Following search and screening, 90 articles were included for review. Interpretation of the evidence suggests that health literacy is a relational process between people with intellectual disability, support networks and healthcare professionals. Each group experiences particular barriers and facilitators to this process and is impacted by its wider social and environmental contexts. There was limited evidence about how personal characteristics might shape health literacy, particularly intersectional experiences. Discussion and Conclusions: Health literacy is a social practice, with roles and responsibilities shared among people and systems. Healthcare and disability sectors can facilitate health literacy by creating environments that support shared access and use of health information, as well as facilitate choice and decision‐making. Patient or Public Contribution: Collaboration with people with intellectual disability in scoping reviews is an emerging area. We gained the perspectives and feedback of colleagues with lived experience of intellectual disability for the design of the review and interpretation of the evidence. This included meeting with a Lived Experience Reference Group of seven people with intellectual disability to discuss our process and findings and receive their guidance. Their contributions supported how we interpreted the findings and reported the review.

Introduction: Falls are a major health risk for older Australians, causing most injury‐related hospitalisations and deaths in this age group. Despite growth in Australia's older culturally and linguistically diverse (CALD) population, limited data exist on the availability and suitability of falls prevention programmes for this group. This study examines the availability and suitability of such programmes for CALD populations in local government areas (LGAs) in Greater Sydney, NSW. Methods: An audit of publicly available demographic data and falls prevention programme offerings from 20 LGAs was conducted, based on language diversity and Socio‐Economic Indexes for Areas (SEIFA)—Index of Relative Socio‐Economic Disadvantage (IRSD) score. Seven LGAs with the highest and lowest SEIFA‐IRSD scores, plus seven LGAs with the most and least linguistic diversity were included. Data are presented using column charts to identify trends. Results: Fewer programmes were found in areas of greater disadvantage and higher linguistic diversity. Least disadvantaged areas offered more programmes, whilst the most disadvantaged and linguistically diverse areas offered fewer. Only one programme was offered in a language other than English, in a least disadvantaged LGA (Ku‐Ring‐Gai). These trends suggest that programme availability does not align with community needs. Conclusions: Disparities exist in falls prevention programme availability across LGAs, with fewer programmes in areas of higher disadvantage and linguistic diversity, highlighting access inequities for older CALD populations. So What?: Older CALD populations in high‐need LGAs have reduced access to falls prevention programmes, signalling a need for targeted, culturally and linguistically appropriate health promotion initiatives.

The use of generative artificial intelligence has grown explosively in professional and educational settings. For health professional education this poses a fundamental tension: early institutional messaging has often discouraged AI use, yet graduates will increasingly encounter AI use in management and health policy contexts. This teaching innovation case study describes the redesign of an assessment task in a large postgraduate health management course (n=410) to require rather than prohibit generative AI use, with the explicit goal of developing critical AI literacy. The intervention drew on Bearman et al.’s concept of evaluative judgment and critical AI literacy. It involved adding a structured reflection component requiring students to use AI to analyse an organisational strategic plan and critically appraise its outputs. Analysis of student feedback (n=156 course evaluation responses; n=127 supplementary evaluation responses) reveals that while the approach was largely well-received, important tensions exist. Some students experienced anxiety stemming from prior prohibitive messaging about generative AI use in other courses, others found the AI component distracting from substantive course content, and many engaged with AI instrumentally rather than critically. Grade distributions showed improvement compared to prior years (M=87.8%, SD=7.9% in intervention year versus M=81.7%, SD=12.8% in prior year), though multiple factors including enhanced scaffolding and cohort composition changes mean we cannot regard this innovation alone as causal. The intervention achieved its primary aim of normalising AI engagement while exposing students to its limitations, though deeper critical evaluation was more elusive than anticipated. Our findings suggest that developing critical AI literacy in health professional education requires careful sequencing within courses, explicit scaffolding through prompting frameworks, clear alignment with professional relevance, and ultimately program-level integration rather than isolated assessment innovations.

Background: Medical complications of pregnancy provide a window into a woman’s future health risk. Hypertensive disorders of pregnancy (HDP) affect 1 in 10 pregnant women and elevate the risk for women of experiencing long-term health complications within 5 years of the affected pregnancy, continuing lifelong. These risks include a doubled to tripled risk of developing cardiovascular disease, a doubled risk of developing type 2 diabetes, and a 5- to 10-fold risk of developing chronic kidney disease. Early assessment and intervention following HDP are therefore crucial to improving women’s life-course health trajectory, as well as outcomes for any subsequent pregnancies. However, previous research has shown that Australian women and their primary health care providers are largely unaware of ongoing health risks and the necessary follow-up screening and assessments. Primary care providers also receive inadequate hospital-to-community handover and support to promote preventive health measures to women following pregnancy complications. Consequently, post-HDP care remains insufficient for optimizing long-term health. Objective: This study aims to (1) explore whether a post-HDP education and follow-up service package can be designed, developed, and implemented among targeted general practitioners (GPs) and maternity hospitals across Sydney, Australia, and (2) evaluate whether the post-HDP education and follow-up package can address knowledge gaps among health care providers regarding the long-term health risks after HDP and build capacity among GPs to implement evidence-based care. Methods: This pilot study will design, develop, and implement a post-HDP education and follow-up package (“the package”) adopting a collaborative and implementation methodological approach. The package, designed by expert health care providers and informed by prior evidence-based research, will include educational materials, improved hospital-to-community handover, and a funded 6-month postpartum visit. Results: Data collection occurred over an 18-month implementation and follow-up period between April 2024 and October 2025. Sixteen GPs across the Central and Eastern Primary Health Network (CESPHN) were recruited, along with their antenatal shared care (ANSC) affiliated tertiary referral hospitals in Sydney. Postimplementation data collection and analysis is planned for completion throughout 2026. Conclusions: Mixed methods evaluation will assess the efficacy, acceptability, and utility of the post-HDP package among health care providers and inform its suitability for deployment at scale.

Background People from South Asian backgrounds, including those of Bangladeshi and Nepalese origin, have a disproportionate burden of chronic diseases, i.e., diabetes and cardiovascular diseases. While preventive services are essential, these population groups demonstrated limited access to existing preventive services in Australia. The present study explored the barriers and facilitators to accessing preventive care services among people from Bangladeshi and Nepalese origins living in Sydney, Australia. Methods This qualitative study was conducted following the constructivist paradigm, where realities are constructed on the lived experiences of the participants. Six focus group discussions (FGDs) and 22 in-depth interviews (IDIs) were conducted during August 2024 and January 2025 with people of Bangladeshi and Nepalese origin living in Sydney. FGDs and IDIs were conducted in participants’ language, transcribed, translated into English, and thematically analysed. The barriers and facilitators at different levels were structured following the socio-ecological framework. Results Several barriers and facilitators were identified across different levels of the socioecological framework. Individual-level barriers included cultural and religious perceptions, limited health literacy, and a lack of awareness of preventive services. Interpersonal barriers included limited English language skills, a lack of translated health education materials and interpreter services and limited cultural understanding among health service providers. Community-level barriers involved chronic disease-related stigma and lack of community engagement. Institutional and policy barriers included limited culturally tailored support and infrequent public transport to health facilities. Conversely, facilitators included self-awareness and ownership of health, knowledge about available preventive services, peer support, cultural and linguistic competency of health care providers, use of digital and social media for health information sharing, and the role of community organisations. Conclusion These findings suggest implementing multi-level, culturally tailored, community-led interventions leveraging community and social engagement platforms to ensure adequate access to available preventive services for chronic diseases among these disadvantaged population groups in Australia.