Background
Methods
Study design and setting
Participants
Community mental health services
Clinicians
Clients
Intervention
Preventive care
Practice change intervention
Data collection procedures
Recruitment
Measures
Statistical analysis
Intervention effectiveness
Results
Sample characteristics
Group 1 | Group 2 | ||||
---|---|---|---|---|---|
Variable | Class | Baseline (n = 110) | Follow-up (n = 677) | Baseline (n = 695) | Follow-up (n = 305) |
Gender | Male | 49 (45 %) | 310 (46 %) | 327 (47 %) | 143 (47 %) |
Age | <40 | 53 (48 %) | 320 (47 %) | 366 (53 %) | 160 (52 %) |
40–49 | 19 (17 %) | 154 (23 %) | 151 (22 %) | 61 (20 %) | |
50–59 | 22 (20 %) | 109 (16 %) | 94 (14 %) | 46 (15 %) | |
60+ | 16 (15 %) | 94 (14 %) | 84 (12 %) | 38 (12 %) | |
Index of disadvantagea
| Lower half | 92 (84 %) | 606 (90 %) | 363 (53 %) | 154 (51 %) |
Higher half | 17 (16 %) | 69 (10 %) | 328 (47 %) | 150 (49 %) | |
Remotenessb
| Major cities | 0 (0 %) | 5 (0.7 %) | 526 (76 %) | 197 (65 %) |
Regional/remote | 109 (100 %) | 670 (99 %) | 165 (24 %) | 107 (35 %) | |
Aboriginality | Aboriginal and/or Torres Strait Islander | 8 (7.3 %) | 88 (13 %) | 35 (5.0 %) | 21 (6.9 %) |
Marital status | Not living with a partner | 69 (63 %) | 426 (63 %) | 530 (76 %) | 213 (70 %) |
Living with partner | 41 (37 %) | 248 (37 %) | 165 (24 %) | 92 (30 %) | |
Education | Some high school or less | 66 (60 %) | 338 (50 %) | 319 (46 %) | 129 (42 %) |
Completed high school | 14 (13 %) | 93 (14 %) | 134 (19 %) | 49 (16 %) | |
TAFE certificate or diploma | 19 (17 %) | 171 (25 %) | 157 (23 %) | 88 (29 %) | |
University, CAE, degree or higher | 11 (10 %) | 75 (11 %) | 84 (12 %) | 39 (13 %) | |
Employment | Employed | 17 (15 %) | 191 (28 %) | 153 (22 %) | 79 (26 %) |
Not working | 64 (58 %) | 307 (45 %) | 381 (55 %) | 151 (50 %) | |
Retired | 11 (10 %) | 68 (10 %) | 58 (8.3 %) | 27 (8.9 %) | |
Other | 18 (16 %) | 111 (16 %) | 103 (15 %) | 48 (16 %) | |
Psychiatric diagnosisc
| Depression | 54 (49 %) | 443 (65 %) | 392 (56 %) | 198 (65 %) |
Bipolar disorder | 24 (22 %) | 77 (11 %) | 139 (20 %) | 70 (23 %) | |
Schizophrenia/psychosis | 17 (15 %) | 82 (12 %) | 207 (30 %) | 54 (18 %) | |
Anxiety | 29 (26 %) | 268 (40 %) | 226 (33 %) | 130 (43 %) | |
Appointments in previous 12 months | 1–2 | 34 (31 %) | 532 (79 %) | 159 (23 %) | 152 (50 %) |
3–11 | 47 (43 %) | 140 (21 %) | 221 (32 %) | 109 (36 %) | |
12+ | 29 (26 %) | 5 (<1 %) | 315 (45 %) | 44 (14 %) | |
Risk status | Smoking | 49 (45 %) | 340 (50 %) | 355 (51 %) | 122 (40 %) |
Physical inactivity | 49 (45 %) | 232 (34 %) | 332 (48 %) | 134 (44 %) | |
Alcohol over consumption | 50 (45 %) | 294 (43 %) | 309 (44 %) | 126 (41 %) | |
Fruit and vegetable under consumption | 98 (89 %) | 557 (82 %) | 611 (88 %) | 251 (82 %) | |
Number of risks | 0 | 4 (3.6 %) | 43 (6.4 %) | 26 (3.7 %) | 19 (6.2 %) |
1 | 22 (20 %) | 153 (23 %) | 117 (17 %) | 67 (22 %) | |
2 | 35 (32 %) | 235 (35 %) | 241 (35 %) | 111 (36 %) | |
3 | 35 (32 %) | 184 (27 %) | 236 (34 %) | 88 (29 %) | |
4 | 14 (13 %) | 62 (9.2 %) | 75 (11 %) | 20 (6.6 %) |
Intervention effectiveness
Outcome | Baseline (n = 805) | Follow-up (n = 982) | Intervention effect |
p value |
---|---|---|---|---|
Odds ratio (95 % CI) | ||||
Risk assessment | ||||
Smoking | 610 (76 %) | 805 (82 %) | 0.87 (0.41–1.83) | 0.712 |
Nutrition | 191 (24 %) | 357 (36 %) | 2.62 (1.25–5.52) | 0.011 |
Alcohol | 632 (79 %) | 820 (84 %) | 1.83 (0.85–3.96) | 0.123 |
Physical activity | 467 (58 %) | 575 (59 %) | 1.03 (0.54–1.95) | 0.934 |
All risks combined | 146 (18 %) | 297 (30 %) | 3.55 (1.56–8.08) | 0.002 |
Brief advicea
| ||||
Smoking | 275 (67 %) | 298 (65 %) | 1.89 (0.73–4.92) | 0.190 |
Nutrition | 186 (26 %) | 267 (33 %) | 2.43 (1.11–5.33) | 0.026 |
Alcohol | 222 (62 %) | 238 (57 %) | 1.44 (0.54–3.81) | 0.468 |
Physical activity | 234 (61 %) | 191 (52 %) | 0.38 (0.14–0.99) | 0.048 |
All applicable risks combined | 185 (24 %) | 250 (27 %) | 1.33 (0.62–2.87) | 0.468 |
Referrala
| ||||
Smoking referral (any)b
| 173 (42 %) | 224 (48 %) | 2.16 (0.86–5.4) | 0.101 |
Nutrition referral (any)c
| 128 (18 %) | 174 (22 %) | 1.36 (0.56–3.29) | 0.493 |
Alcohol referral (any)d
| 127 (35 %) | 153 (36 %) | 1.01 (0.37–2.75) | 0.981 |
Physical activity referral (any)c
| 123 (32 %) | 113 (31 %) | 1.04 (0.38–2.84) | 0.947 |
Referral—all applicable risks (any)b,c,d
| 0 (0 %) | 12 (1.3 %) | 0.93 (0.19–4.5) | 0.925 |
Letter to primary care provider | 206 (26 %) | 227 (23 %) | 0.66 (0.32–1.34) | 0.249 |
Additional referral outcomesa,e
| ||||
Smoking arrangef
| 11 (2.7 %) | 11 (2.4 %) | ||
Nutrition arrangef
| 5 (0.7 %) | 40 (5.0 %) | ||
Physical activity arrangef
| 7 (1.8 %) | 11 (3.0 %) | ||
Smoking—primary care provider | 52 (13 %) | 79 (17 %) | ||
Nutrition—primary care provider | 6 (0.8 %) | 25 (3.1 %) | ||
Alcohol—primary care provider | 38 (11 %) | 41 (9.8 %) | ||
Physical activity—primary care provider | 5 (1.3 %) | 6 (1.6 %) |
Group 1 | Group 2 | |||||||
---|---|---|---|---|---|---|---|---|
Outcome | Baseline (n = 110) | Follow-up (n = 677) | Intervention effect |
p value | Baseline (n = 695) | Follow-up (n = 303) | Intervention effect |
p value |
Odds ratio (95 % CI) | Odds ratio (95 % CI) | |||||||
Risk assessment | ||||||||
Smoking | 95 (86 %) | 554 (82 %) | 0.61 (0.22–1.68) | 0.340 | 515 (74 %) | 251 (82 %) | 1.27 (0.50–3.23) | 0.621 |
Nutrition | 17 (15 %) | 241 (36 %) | 2.83 (1.11–7.22) | 0.030 | 174 (25 %) | 116 (38 %) | 2.47 (0.98–6.19) | 0.054 |
Alcohol | 89 (81 %) | 554 (82 %) | 0.78 (0.30–2.04) | 0.613 | 543 (78 %) | 266 (87 %) | 2.78 (1.02–7.56) | 0.045 |
Physical activity | 66 (60 %) | 387 (57 %) | 0.72 (0.33–1.57) | 0.410 | 401 (58 %) | 188 (62 %) | 1.49 (0.65–3.39) | 0.343 |
All risks combined | 14 (13 %) | 202 (30 %) | 2.65 (0.99–7.08) | 0.053 | 132 (19 %) | 95 (31 %) | 3.75 (1.36–10.34) | 0.011 |
Brief advicea
| ||||||||
Smoking | 34 (61 %) | 217 (64 %) | 1.46 (0.47–4.52) | 0.510 | 241 (68 %) | 81 (66 %) | 1.93 (0.55–6.80) | 0.308 |
Nutrition | 18 (18 %) | 177 (32 %) | 5.55 (1.98–15.55) | 0.001 | 168 (27 %) | 90 (36 %) | 2.07 (0.78–5.52) | 0.144 |
Alcohol | 26 (52 %) | 158 (54 %) | 1.51 (0.50–4.55) | 0.466 | 196 (63 %) | 80 (63 %) | 1.26 (0.35–4.56) | 0.726 |
Physical activity | 28 (57 %) | 120 (52 %) | 0.42 (0.12–1.49) | 0.179 | 206 (62 %) | 71 (53 %) | 0.38 (0.11–1.31) | 0.125 |
All applicable risks combined | 15 (14 %) | 162 (26 %) | 2.32 (0.85–6.33) | 0.100 | 170 (25 %) | 88 (31 %) | 1.08 (0.42–2.80) | 0.876 |
Referrala
| ||||||||
Smoking referral (any)b
| 21 (38 %) | 160 (47 %) | 1.49 (0.49–4.56) | 0.482 | 152 (43 %) | 64 (52 %) | 2.64 (0.80–8.70) | 0.110 |
Nutrition referral (any)c
| 11 (11 %) | 114 (20 %) | 1.59 (0.54–4.74) | 0.402 | 117 (19 %) | 60 (24 %) | 1.32 (0.44–3.97) | 0.618 |
Alcohol referral (any)d
| 19 (38 %) | 102 (35 %) | 0.84 (0.27–2.68) | 0.773 | 108 (35 %) | 51 (40 %) | 1.50 (0.40–5.57) | 0.544 |
Physical activity Referral (any)c
| 9 (18 %) | 68 (29 %) | 6.37 (1.44–28.25) | 0.015 | 114 (34 %) | 45 (34 %) | 0.54 (0.16–1.88) | 0.334 |
Referral—all applicable risks (any)b,c,d
| 0 (0 %) | 8 (1.3 %) | 1.02 (0.02–58.88) | 0.993 | 0 (0 %) | 4 (1.4 %) | -e
| -e
|
Letter to primary care provider | 44 (40 %) | 156 (23 %) | 0.81 (0.35 –1.91) | 0.637 | 162 (23 %) | 71 (23 %) | 1.04 (0.40–2.68) | 0.940 |
Intervention implementation
Monthly intervention strategies | Average number who received strategy per montha
| ||
Group 1b
| Group 2c
| Overall | |
Practice change support officer contacts | |||
Face-to-face visits (managers) | 1.6/3 (53 %) | 7.6/10 (76 %) | 9.2/13 (71 %) |
Face-to-face visits (clinicians)d
| 4.8/7 (69 %) | 8.7/12 (73 %) | 13.4/19 (71 %) |
Fortnightly phone/email support (managers) | 1.8/3 (60 %) | 8.3/10 (83 %) | 10.1/13 (78 %) |
Monitoring and feedback | |||
Performance reports provided (managers)e
| 1.4/3 (47 %) | 7.5/10 (75 %) | 8.9/13 (68 %) |
Performance reports discussed with (managers)e
| 1.0/3 (33 %) | 7.2/10 (72 %) | 8.2/13 (63 %) |
Practice change resources | |||
Tips and updates sheets provided to clinicians (service)f
| 3.4/7 (49 %) | 9.0/12 (75 %) | 12.4/19 (65 %) |
Newsletter provided to clinicians (service)f
| 4.4/7 (63 %) | 9.0/12 (75 %) | 13.4/19 (71 %) |
One-off intervention strategiesg
| Month by which majority of target (80 % ) received strategyh
| ||
Group 1b
| Group 2c
| Overall | |
Clinician and manager training | |||
Manager training (managers) | 5/12 | 4/12 | 5/12 |
Online training (managers) | n/ai
| 4/12 | 5/12 |
Online training (clinicians) | 7/12 | 5/12 | 6/12 |
Practice change resources | |||
Provision of resource pack (service)f
| 4/12 | 1/12 | 3/12 |